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THE CARE AND FEEDING 
OF CHILDREN 



THE CARE AND FEEDING 
OF CHILDREN 

A CATECHISM FOR THE USE OF MOTHERS 
AND CHILDREN'S NURSES 



BY 

L. EMMETT HOLT, M.D., LL.D. 

PROFESSOR OF DISEASES OF CHILDREN IN THE COLLEGE OF PHYSICIANS 

AND SURGEONS (COLUMBIA UNIVERSITY) 

ATTENDING PHYSICIAN TO THE BABIEs' HOSPITAL AND THE 

FOUNDLING HOSPITAL, NEW YORK 



CiBiJtf) Cbition, SRebigeli anb CnlargeD 



NEW YORK AND LONDON 

D. APPLETON AND COMPANY 
1917 



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CoPYBiaHT, 1S94, 1897, 1903, 1906, 1909, 1912, 1914, 1915, bt 
D. APPLETON AND COMPANY 

-1 



Printed in the United States of America 



TO 
THE YOUNG MOTHERS OF AMERICA, 

TOWARD THE SOLUTION OF WHOSE PROBLEMS 
THESE PAGES HAVE BEEN DEVOTED, 

THIS WORK 

IB RESPECTFULLY DEDICATED 

BY THE AUTHOR. 



PREFACE TO THE EIGHTH EDITION 



The constant use of the Catechism as a manual 
y^^QiY nursery maids has shown the need of fuller treat- 
ment of several subjects than was given in the earlier 
editions. An attempt has been made to meet the 
needs of mothers and nurses outside of institutions 
who have made the book a nursery guide, especially 
in matters relating to older children. 

The author's aim has been not to alarm the mother 
by acquainting her with all the possible diseases and 
accidents which may befall her child, but to open 
her eyes to matters which are her direct and chief 
concern. 

It is, therefore, the needs of the well child, not 
the sick one, which have been considered. The well 
child must, in most cases, be left to the care of the 
mother or nurse for whose guidance and assistance 
these pages are intended. For directions in matters 
of illness, however, no mother or nurse should de- 

7 



8 THE CARE AND FEEDING OF CHILDREN 

pend upon any manual, but upon the advice of a 
physician. 

It is hoped that the mothers and nurses who have 
found the earlier editions of the Catechism helpful 
in the solution of some of their nursery problems 
will find even greater assistance from the present 
lume. 



New York 1915 



CONTENTS 



I 

THE CARE OF CHILDREN 

PAGE 

Bathing 15 

Genital organs 16 

Eyes 17 

Mouth 18 

Skin 19 

Clothing . . . . 21 

Napkins . - 24 

Nursery c . 25 

Airing 27 

Weight, growth, and deveicpment 31 

Dentition 37 

n 

INFANT FEEDING 

Nursing 44 

Weaning from the breast . . . . . . . .53 

Weaning from the bottle 55 

Artificial feeding 58 

Selection and care of milk used for infant feeding . . 58 

Modification of cow's milk 63 

Cream, 67; top milk, 68. 
9 



10 THE CAEE AND FEEDING OE CHILDEEN 

PAGE 

Food for healthy infants 69 

Formulas from whole milk, 73; formulas from 
7-per-cent milk, 75. 

Intervals of feeding . . . 76 

Schedule of quantities and intervals for first year . . 77 

Preparation of milk at home 79 

Directions for feeding : . 82 

General rules for guidance in feeding 84 

How to begin, 84; increasing the food, 85; reducing 
the food, 88. 

Regularity in feeding 90- 

Overfeeding 91 

Common mistakes in infant feeding 93 

Changes in food required by special symptoms ... 94 
Loss of appetite, 94; vomiting, 95; colic, 98; constipa- 
tion, 99; hot weather, 100; no gain in weight, 100; 
use of condensed milk, 102; slight indisposition, 103; 
acute iUness, 103; diarrhcea, 104. 

Addition of other food 105 

Use of fruit juices, 105; beef juice, 106; broths, 107; 
eggs, 107; toast and crackers, 107. 

Substitutes for fresh milk . 108 

Sterilized milk . . . . ' . . . ... 109 

Pasteurized milk . . . 110 

Modified milk from the milk laboratories . . . .114 

Frozen milk 115 

Peptonized milk 116 

Condensed milk 116 

Buttermilk 119 

Casein or protein milk 119 

Feeding during the second year 121 

Schedule for twehth to fifteenth month .... 122 
Schedule for fourteenth to eighteenth month . . .123 



CONTENTS 11 



PAGE 

Schedule for eighteenth to twenty-fourth month . . . 124 
Feeding during the third year 126 

III 
THE DIET OF OLDER CHILDREN • 

Milk and cream 131 

Eggs 133 

Meats and fish 134 

Vegetables . . . . . 135 

Cereals 137 

Broths and soups 138 

Bread, crackers, and cakes 139 

Desserts 139 

Fruits 141 

Indigestion in older children . 143 

Acute indigestion, 143; chronic indigestion, 145. 
General rules to be observed in feeding ..... 147 

Food formulas 150 

Beef juice, 150; mutton broth, 151; chicken, veal, and 
beef broths, 151; scraped beef or meat pulp, 152; 
junket curds, and whey, 152; barley water, 152; bar- 
ley jelly, 153; rice, wheat, oat water, 153; oat, wheat, 
rice jelly, 154; albumin water, 154; lime-water, 154; 
dried bread, 155; coddled egg, 155. 

IV 
MISCELLANEOUS 

Bowels . , . . . .160 

Sleep . 161 

Causes of disturbed sleep 163 



12 THE CARE AND EEEDING OF CHILDREN 

PAOB 

Exercise . 165 

Cry 166 

Lifting children 168 

Temperature 169 

Nervousness 171 

Playing with babies 171 

Toys 172 

Kissing , . . 174 

Convulsions 174 

Foreign bodies swallowed 175 

Foreign bodies in the ear 177 

Foreign bodies in the nose 177 

Cohc 177 

Earache 178 

Croup 179 

Contagious diseases 180 

Measles, 180; German measles, 181; scarlet fever, 
181; whooping cough, 182; chicken pox, 182; diph- 
theria, 182; mumps, 183. 

Treatment for commenciug illness 184 

Nursery training to help the doctor 185 

Scurvy 185 

Constipation . . . 187 

Diarrhoea 189 

Bad habits 190 

Vaccination 194 

Adenoids "^ . . . . 195 

Enlarged tonsils . 197 

Weight charts 199, 200 

Index 203 



PART I 
THE CARE OF CHILDREN 



THE CARE AND FEEDING OF 
CHILDREN 



THE CARE OF CHILDREN 

BATHING 

Ai wTiai age may a child he given a full iub hath f 
TJsuallj when ten days old; it should not be 
given before the cord has come off. 

How should the hath he given? 

It should not be given sooner than one hour after 
feeding. The room should be warm; if possible 
there should be an open fire. The head and face 
should first be washed and dried; then the body 
should be soaped and the infant placed in the tub 
with its body well supported by the hand of the 
nurse. The bath should be given quickly, and the 
body dried rapidly with a soft towel, but with very 
little rubbing. 

At what temperature should the hath he given? 
For the first few weeks at 100° F. ; later, dur- 

15 



16 THE CARE AND FEEDING OF CHILDEE^"^ 

ing early infancy, at 98° F. ; after six month -^j at 
95° F.; during the second year, from 85° to 90"^ F. 

With what should the hath he given? 

Soft sponges are useful for bathing the bciy, 
limbs and scalp. There should be a separate wash- 
cloth for the face and another for the buttocks. 

What are the ohjections to hath sponges? 

When used frequently, they become very dirty 
and are liable to cause infection of the eyes, mouth, 
or genital organs. 

Under ivhat circumstances should the daily tub 
hath he omitted? 

In the case of very feeble or delicate infants on 
account of the exposure and fatigue, and in all forms 
of acute illness except by direction of the physician. 
In eczema and many other forms of skin disease 
much harm is often done by bathing with soap and 
water, or even with water alone. 

GENITAL OEGAI^S 

How should the genital organs of a female child 
he cleansed? 

Best with fresh absorbent cotton and tepid water, 
or a solution of boric acid, two teaspoonfuls to the 
pint. This should be done carefully at least once a 



^r EYES * 17 

day. If any discharge is present, the boric-acid so- 
lution should invariably be used twice a day. Great 
ca: 3 is necessary at all times to prevent infection 
which often arises from soiled napkins. 

Hoiv should the genital organs of a male child 
he cleansed? 

In infancy and early childhood the foreskin 
should be pushed completely back at least twice a 
week while the child is in his bath, and the parts 
thus exposed washed gently with absorbent cotton 
and water, afterwards drawn forward again. 

If the foreskin is tightly adherent and cannot 
readily be pushed back, the physician's attention 
should be called to it. The nurse or mother should 
not attempt forcible stretching. 

When is circumcision advisable? 

Usually, when the foreskin is very long and so 
tight that it cannot be pushed back without foiyie; 
always, when this condition is accompanied by evi- 
dences of local irritation or difficulty in passing 
water. 

EYES 

How should the eyes of a little hahy he cleansed? 
With a piece of soft linen or absorbent cotton 



18 



THE CAEE AND FEEDING OF CHILDREN 



and a lukewarm solution of salt or boric acid, — one 
even teaspoonful to one pint of water. 

If pus appears in the eyes, what should he 
done? ~ 

They should be cleansed every hour with a solu- 
tion of boric acid (ten grains to one ounce of water). 
If the lids stick together, a little vaseline from a tube 
should be rubbed upon them at night. If the trouble 
is slight, this treatment will control it ; if it is severe, 
a physician should be called immediately, as delay 
may result in loss of eyesight. 

MOUTH 



-^ 



How is an infant's mouth to he cleansed? 

An excellent method is by the use of a swab made 
by twisting a bit of absorbent cotton upon a wooden 
toothpick. With this the folds between the gums and 
lips and cheeks may be gently and carefully cleansed 
twice a day unless the mouth is sore. It is not neces- 
sary after every feeding. The finger of the nurse, 
often employed, is too large and liable to injure the 
delicate mucous membrane. 

What is sprue? 

It appears on the lips and inside the cheeks like 
^^ttle white threads or flakes'. It is also called thrusL 



SKIN 19 

In bad cases it may cover the tongue and the whole 
of the inside of the mouth. 

How should a mouth he cleansed when there is 
sprue ? 

It should he washed carefully after every feeding 
or nursing with a solution of borax or bicarbonate of 
soda (baking soda), one even teaspoonful to three 
ounces of water, and four times a day the boric-acid 
solution mentioned on previous page should be used.. 



SKIN 

How should the infant's shin he cared for to pre- 
vent chafing? 

First, not too much nor too strong soap should be- 
used ; secondly, careful rinsing of the body ; thirdly, 
not too vigorous rubbing, either during or after the- 
bath; fourthly, the use of dusting powder in all the 
folds of the skin, — under the arms, behind the ears, 
about the neck, in the groin, etc. This is of tha 
utmost importance in very fat infants. 

If the shin is very sensitive and chafing easily 
produced, what should he done f 

l^o soap should be used, but bran or salt baths, 
given instead. 



20 THE CARE AND FEEDING OF CHILDREN 

How should a hran hath he prepared? 

One pint of wheat bran should be placed in a bag 
of coarse muslin or cheese-cloth, and this put in the 
bath water. It should then be squeezed for five min- 
utes, until the water resembles a thin porridge. 

Hoiu should a salt hath he prepared? 
A teacupful of common salt or sea salt should be 
used to each two gallons of water. 

How should the huttocl^s he cared for? 

This is the most common place for chafing, as the 
parts are so frequently wet and soiled; hence the 
utmost pains should be taken that all napkins be re- 
moved as soon as thev are wet or soiled, and the parts 
kept scrupulously clean and well powdered. 

If the parts have become chafed, what should he 
done ? 

Only bran and salt baths should be used, and in 
very severe cases even these may have to be omitted 
for a day or two. The parts may be cleansed with 
sweet oil and a little absorbent cotton, and the skin 
kept covered with a dusting powder composed of 
starch two parts, boric acid one part. 

What is pricMy heat, and how is it produced? 

It consists of fine red pimples, and is usually 
caused by excessive perspiration and the irritation of 
flannel underclothins:. 



CLOTHING 21 



How should it he treated f 

Lighter clothing should be used ; muslin or linen, 
should be put next to the skin; the entire body 
should be sponged frequently with equal parts of 
vinegar and water, and plenty of the starch and 
boric-acid powder mentioned should be used. 



CLOTJllNGr 

What are the most essential things in the clothings 
of i7ifants? 

That the chest should be covered \vith soft flannel, 
the limbs well protected but not confined, and the- 
abdomen supported by a broad flannel band, which, 
should be snug but not too tight. It is important 
that the clothing should fit the body. If it is too 
tight it interferes with the free movements of the- 
chest in breathing, and by pressing upon the stomach, 
sometimes causes the infant to vomit soon after swal- 
lowing its food. If the clothing is too loose it is. 
soon thrown into deep folds or bunches, which cause- 
much discomfort. !N'o pins should be used, but, in- 
stead, all bands about the body should be basted. 
The petticoats should be supported by shoulder 
straps. 



-22 THE CARE AND FEEDING OF CHILDEEN 

How should the infant he held during dressing 
and undressing? 

IsTothing is more awkward than to attempt to 
dress a young baby in a sitting posture. It should 
lie upon the nurse's lap until quite old enough to 
sit alone, the clothing being drawn over the child's 
feet, not slipped over the head. 

Of what use is the hand? 

It protects the abdomen, but its most important 
use is to support the abdominal walls in very young 
infants, and in this way to prevent the occurrence of 
rupture. 

How long is this hand required? 

The snug flannel band, not usually more than 
three or four months. In healthy infants with plenty 
•of fat this may then be replaced by the knitted band, 
which may be worn up to eighteen months. The 
band is an important article of dress in the case of 
thin infants whose abdominal organs are not suffi- 
ciently protected by fat. With such, or with those 
prone to diarrhoea, it is often advisable to continue 
the band until the third or fourth year. 

What changes are to he made in the clothing of 
infants in the summer? 

Only the thinnest gauze flannel undershirts 
should be worn, and changes in temperature should 



CLOTHING 23 



be met by changes in the outer garments. The great- 
est care should be taken that children are not kept 
too hot in the middle of the day, while extra wraps 
should be used morning and evening, especially at 
the seashore or in the mountains. 

Should older children he allowed to go with their 
legs hare? 

If strong and well there is no objection to this in 
hot weather. In cold weather, however, it is doubt- 
ful if any children are benefited by it, particularly 
in a changeable climate like that of iN'ew York. 
Many delicate children are certainly injured by such 
attempts at hardening. 

What sort of underclothing should he worn dur- 
ing cold weather? 

^Never the heaviest weight, even in winter. Four 
grades are usually sold, the next to the heaviest being 
thick enough for any child. 

Do little children require as heavy flannels as 
older people? 

Not as a rule. They usually live in a ^arm 
nursery; their circulation is active; and they always 
perspire easily during their play. When they go out 
of doors, the addition of coats and leggings renders 
thick flannels unnecessary. 



24 THE CAEE AND FEEDING OF CHILDREN 

Are not many little children clothed too thinly 
for the ordinary house? 

Yevj few. The almost invariable mistake made 
in city homes is that of excessive clothing and too 
v^^arm rooms. These two things are among the most 
frequent reasons for their taking cold so easily. 



N^APKINS 

How should napJcms he talcen care of? 

They should be immediately removed from the 
nursery when soiled or wet. Soiled napkins should 
be kept in a receptacle with a tight cover, and washed 
as soon as possible. 

Should napkins which have been only wet he 
used a second time ivithout vjashing? 

It is no doubt better to use only fresh napkins, 
but there is no serious objection to using them twice 
unless there is chafing of the skin. Clean napkins, 
changed as soon as wet or soiled, are of much im- 
portance in keeping the skin healthy. 

What are the important things to he ohserved in 
washing napkins? 

Soiled napkins should not be allowed to dry, but 
should receive a rough washing at once; they should 



NURSERY 25 



then be kept in soak in plain water until a conve- 
nient time for washing, — at least once every day, — 
when they should be washed in hot suds and boiled 
at least fifteen minutes. Afterward they should be 
very thoroughly rinsed or they may irritate the skin, 
and ironed without starch or blueing. They should 
never be used when damp. 



NURSERY 

What are the essentials in a good nursery? 

The furnishings should be very simple, and un- 
necessary hangings and upholstered furniture should 
be excluded. As large a room as possible should be 
selected — one that is well ventilated, and always one 
in which the sun shines at some part of the day, as 
it should be remembered that an average child spends 
here at least three fourths of its time during the first 
year. The nursery should have dark shades at the 
windows, but no extra curtains; about the baby's 
crib nothing but what can be washed should be al- 
lowed. The air should be kept as fresh and as pure 
as possible. There should be no plumbing, no dry- 
ing of napkins or clothes, no cooking of food, and 
no gas burning at night. A small wax night-light 
answers every purpose. 



26 THE CARE AXD FEEDING OF CHILDREN 

How should a nursery he heated? 

Best by an open fire ; next to this by a Franklin 
stove. The ordinary hot-air furnace of cities has 
many objections, but it is not so bad as steam heat 
from a radiator in the room. A gas stove is even 
worse than this, and should never be used, except, 
perhaps, for a fev7 minutes during the morning 
bath. 

At what temperature should a nursery he kept 
during the day? 

Best, 64° to 68° F., measured by a thermometer 
hanging three feet from the floor. The tempera- 
ture should not be allowed to go above 70° F. 

At what temperature during the night? 

During the first two or three months, not below 
65° F. After three months the temperature may go 
as low as 55° F. After the first year it may be 50° 
or even 45° F. 

At what age may the ivindow he left open at 
night ? 

Usually after the third month, except when the 
outside temperature is below freezing point. 

How often should the nursery he aired? 

At least twice a day — in the morning after the 
child's bath, and again in the evening before the 
child is put to bed for the night. This should be 



AIRING 27 



done thoroughly, and the child should be removed 
meanwhile to another apartment. It is well to air 
the nursery whenever the child is out of the room. 

What symptoms are seen in a child who is kept 
in too hot a room? 

It becomes pale, loses appetite, shows symptoms 
of indigestion, occasionally vomits, stops gaining in 
weight, perspires very much, and takes cold easily 
because of this and also because of the great differ- 
ence between the indoor and outdoor temperatures. 
Its condition may be such as to lead one to suspect 
very serious illness. 



AIEING 

How early may airing indoors he commenced and 
how long may it he continued? 

Airing in the room may be begun with a strong, 
healthy child, even in cold weather, when he is one 
month old, at first for only fifteen or twenty min- 
utes at a time. This period may be gradually length- 
ened by ten or fifteen minutes each day until it is 
four or five hours. This airing may be continued in 
almost all kinds of weather. 



28 THE CAEE AND FEEDING OF CHILDEEN 

Is there not great danger of a young hahy's tak- 
ing cold ivlien aired in this manner? 

Xot if the period is at first short and the baby 
accustomed to it graduallY. Instead of rendering the 
child liable to take cold, it is the best means of pre- 
venting colds. 

Hoiu should such an airing he given? 

The child shonld be dressed with bonnet and light 
coat as if for the street and placed in its crib or car- 
riage which shonld stand a few feet from the win- 
dow. All the windows are then thrown wide open, 
bnt the doors closed to prevent draughts. Screens 
are unnecessary 

At ivhat age may a child go out of doors? 

In summer, when one week old; in spring and 
fall, usually at about one month; in winter, when 
about three months old, but only on pleasant days, 
being kept in the sun and out of the wind. 

What are the best hours for ailing out of doors? 

In summer and early autumn a child may be out 
almost any time between seven in the morning and 
sunset; in winter and early spring, a young child 
only between 10 or 11 a. :m. and 3 p. m.^ although 
this depends somewhat upon the climate. In !N'ew 



AIRING 29 



York and along the Atlantic coast the early morn- 
ings are apt to be damp and the afternoons raw and 
cloudy. 

On what hind of days should a hahy not go out? 

In sharp winds, when the ground is covered with 
melting snow, and when it is extremely cold. A child 
under four months old should not usually go out if 
the thermometer is below freezing point; nor one 
under eight months old if it is below 20° F. 

Exceptions to all the above statements are to be 
made in the case of very small and especially deli- 
cate infants. Though they should have fresh air in 
abundance, they should be much more carefully pro- 
tected against cold. 



What are the most important things to he attended 
to when the child is out in its carriage? 

To see that the wind never blows in its face, that 
its feet are properly covered and warm, and that the 
sun is never allowed to shine directly into its eyes 
when the child is either asleep or awake. 

Of what advantage to the child is going out? 

Fresh air is required to renew and purify the 
blood, and this is just as necessary for health and 
growth as proper food. 



30 THE CAEE AND FEEDING OF CHILDEEN 

What are the ejects ^produced in infants hy fresh 
air? 

The appetite is improved, the digestion is better^ 
the cheeks become red, and all signs of health are 
seen. 

Is there any advantage in having a child take 
its airing during the first five or six months in the 
nurse's arms? 

'None whatever. A child can be made much more 
comfortable in a baby carriage, and can be equally 
well protected against exposure by blankets and the 
carriage umbrella. 

What are the ohjections to an infant's sleeping 
out of doors? 

There are no real objections. It is not true that 
infants take cold more easily when asleep than awake, 
while it is almost invariably the case that those who 
sleep out of doors are stronger children and less prone 
to take cold than others. 

What can he done for older children who take 
cold upon the slightest provocation? 

They should be kept in cool rooms, especially 
when asleep. They should not wear such heavy 
clothing that they are in a perspiration much of 
the time. Every morning the body, particularly the 



WEIGHT, GEOWTH, AND DEVELOPMENT 31 

neck, chest, shoulders and back, should be sponged 
with cold water (50° to 60° F.). 

How should this cold sponge hath he given? 

The child should stand in a tub containing a 
little warm water, and a large bath sponge filled with 
cold water should be squeezed two or three times 
over chest and shoulders. For best effects this sponge 
bath should be very cold and very short. It should 
be followed by a vigorous rubbing with a towel until 
the skin is quite red. This may be begun at three 
years, and often at two years. For infants a little 
higher temperature (65° to 70° F.) may be used. 

WEIGHT^ GROWTH^ AND DEVELOPMENT 

Of what importance is the iveight of the child? 

l^othing else tells so accurately how well it is 
thriving. 

During the first year a record of the weight is 
almost indispensable; throughout childhood it is of 
much interest and is the best guide to the physical 
condition. It will well repay any mother or nurse 
to keep such a record. 

How frequently should a child he lueighed? 
Every week during the first six months, and at 
least once in two weeks during the last six months 



32 THE CAEE AND FEEDING OF CHILDREN 



of the first year. During the second year a child 
should be weighed at least once a month. 

How rapidly should an infant gain in weight 
during the first year? 

There is usually a loss during the first week of 
from four to eight ounces ; after this a healthy child 
should gain from four to eight ounces a week up to 
about the sixth month. From six to twelve months 
the gain is less, usually from two to four ounces a 
week. 

Is it to he expected that bottle-fed infants will 
gain as rapidly as those ivho are nursed? 

They seldom do so during the first month ; after 
that time under favourable circumstances the gain 
is usually quite as regular, and during the latter 
half of the first year it is likely to be more con- 
tinuous than in a nursing infant, because the latter 
usually loses weight at the time of weaning. 

Why do they not gain so rapidly at first ? 

It takes a few weeks for the stomach to become 
accustomed to cow^s milk, and until this is accom- 
plished it is necessary to make the milk very weak 
01 the child's digestion will be upset. 



WEIGHT, GEOWTH, AND DEVELOPMENT 33 

For a child of average weight at birth (seven 
to seven and a half pounds) what should he the 
weight at the different periods during the first 
year? 

At three months it should be twelve to thirteen 
pounds ; at six months, fifteen to sixteen pounds ; at 
nine months, seventeen to eighteen pounds; at one 
year, twenty to twenty-two pounds. At five months 
an average healthy child has doubled its weight, and 
at twelve months it has nearly trebled its weight. 

Do all healthy infants gain steadily in weight 
during the first year? 

As a rule they do; yet it is seldom the case that 
one gains every week for the entire year. With most 
infants there are from time to time periods of a few 
weeks in which no gain is made. These are more 
often seen from the seventh to the tenth month and 
frequently occur when the child is cutting teeth, 
sometimes during very hot weather. 

Is it true that every infant who gains rapidly in 
weight is thriving normally f 

!N"ot invariably. Some who are fed upon pre- 
pared infant foods increase rapidly in weight but 
not in strength, nor in their development in other 

respects. 

3 



34 THE CAKE AND FEEDING OF CHILDEEN 

Is the iveight of as much value in the second year 
as a guide to the child's condition f 

After the first year, the gain in weight is seldom 
continuous; there are many interruptions, some de- 
pend on season, and others often occur without ap- 
parent cause. 

At what age should the fontanel close? 

The average is about eighteen months. It seldom 
closes earlier than fourteen months, and it should 
not be open at two years. 

At vjhat age should a child hold up its head? 

As a rule during the fourth month, and often 
during the third month, the head can be held erect 
when the body is supported. 

When does an infant first laugh aloud? 
Usually from the third to the fifth month. 

When does it hegin to reach for toys and handle 
them? 

Usually from the fifth to the seventh month. 

At what age should a child he able to sit and to 
stand alone? 

At seven or eight months a healthy child is usu- 
ally able to sit erect and support the body. During 
the ninth and tenth months are usually seen the first 
attempts to bear the weight upon the feet, and at 



WEIGHT, GROWTH, AND DEVELOPMENT 39 

eleven or twelve months most children can stand with 
assistance. 

When should a child loalh alone? 

The first attempts are generally seen in the 
tv^elfth or thirteenth month. At fifteen or sixteen 
months the average child is able to run alone. 

What conditions postpone these events? 

Prematurity, a very delicate constitution, any 
severe or prolonged illness, and especially chronic- 
disturbances of digestion making feeding difficult. 
A common cause of late sitting, standing, or v^alk^ 
ing is rickets. 

Should a child he urged to walk? 

!Never; he is usually quite willing to do so as- 
soon as his muscles and bones are strong enough. 
ISTone of the contrivances for teaching children to 
walk are to be advised. 

When do children begin to talk ? 

Generally at one year a child can say "papa" 
and "mamma" or other single words. At the end 
of the second year the average child is able to put 
words together in short sentences. 

If at tivo years the child makes no attempt ta 
speak, v;hat should he suspected? 

Either that the child is a deaf-mute or that it is. 



? 



56 THE CAEE AND FEEDING OF CHILDREN 

mentally deficient, although this is occasionally seen 
in children who are in other respects quite normal. 



Table showing the Average Weight, Height, and Circum- 
ference of Head and Chest of Boys^ 

At birth Weight 73^ pounds 

Height 20)^ inches. 

Chest 133^ '' 

Head 14 

One year Weight 21 pounds.^ 

Height 29 inches. 

Chest 18 

Head 18 

Two years Weight 27 pounds. 

Height 32 inches. 

Chest 19 

Head 19 

Three years Weight 32 pounds. 

Height 35 inches 

Chest 20 

Head 19M " 

Four years Weight 36 pounds. 

Height 38 inches. 

Chest 20M '' 

Head 19M " 

Five years Weight 41 pounds. 

Height 413^ inches. 

Chest 21K " 

Head 201^ '' 

^ Weights for the first four years are without clothes. 

The weight of girls is on the average about one pound lesa 
tthan boys. They are about the same in height. 

Charts showing weight curve for the first year, and from one 
-year to fourteen years are given at the end of this book 



DENTITION Sr 



Six years Weight 45 pounds. 

Height 44 iaches. 

Chest 23 

Seven years Weight 493^ pounds. 

Height 46 inches. 

Chest 233^ '' 

Eight years Weight 543^ pounds. 

Height 48 inches. 

Chest 241^ '' 

Nine years Weight 60 pounds. 

Height 50 inches. 

Chest 25 

Ten years W^eight 66>^ pounds. 

Height 52 inches. 

Chest 26 

The above weights are with ordinary house clothes. 



DENTITION 

How many teeth are there in the first set? 
Twenty. 

What is the time of their appearance f 
The two central lower teeth are usually the first 
to appear, and come from the fifth to the nintk 
month ; next are the four upper central teeth, which 
come from the eighth to the twelfth month. The 
other two lower central teeth and the four front 
double teeth come from the twelfth to the eighteenth 
month. Then follow the four canine teeth, the twa 
upper ones being known as the '^eye teeth," and th& 



38 THE CAEE AND FEEDING OF CHILDEEN 

two lower as the ^^stomach teeth"; they generally 
<3ome between the eighteenth and the twenty-fourth 
nionth. The four back double teeth, which complete 
the first set, come between the twenty-fourth and 
thirtieth month. 

At one year a child usually has six teeth. 

At one and a half years, twelve teeth. 

At two years, sixteen teeth. 

At two and a half years, twenty teeth. 

What are the causes of variation? 

The time of appearance of the teeth varies in 
■different families ; in some they come very early, 
in others much later. The teeth may come late as 
a result of prolonged illness and also from rickets. 

What symptoms are commonly seen with teeth- 
ing ? 

In healthy children there is very often fretful- 
ness and poor sleep for two or three nights; there 
may be loss of appetite, so that only one half the 
usual amount of food is taken; there is salivation 
or drooling, and often slight fever; there may be 
some symptoms of indigestion, such as vomiting or 
the appearance of undigested food in the stools. In 
delicate children all these symptoms may be much 
more severe. 



DENTITION 3& 



How long do these sympioms last f 
Usuallj only three or four days; but there may 
be no gain in weight for two or three weeks. 

What is the cause of most of the other symptoms 
attributed to teething? 

Nearly all of them come from indigestion due to 
bad feeding. 



PART II 



II 

INFANT FEEDING 

What is the best infant food? 
Mother's milk. 

Of what is mother s milk composed f 
Thirteen parts solids and eighty-seven water. 

What are the solids? 

Fat, sugar, protein, and salts. 

What is the fat? 
The cream. 

What is the sugar? 

It is lactose, or milk sugar. 

What is the protein? 
The curd of the milk. 

Are all these elements necessary? 
Yes; we cannot expect to rear a healthy infant 
unless thej are all in his food. 

43 



44 THE CAKE AND FEEDING OF CHILDEEN 

Of what use is the fat? 

It is needed for the growth of bones, nerves, the 
fat of the body, and the production of heat. 

Of what use is the sugar f 

It is needed for the production of heat, and to 
make fat in the body. 

Of what u^e is the protein? 

It is needed for the growth of the body cells, 
such as those of the blood, the organs, and the mus- 
cles. 

Of what use are the salts? 
Particularly for the growth of bone. 

Of what use is the water? 

By means of the water the food is kept in a state 
of minute subdivision or in solution, so that the deli- 
cate organs of the infant can digest it. It is also 
necessary to enable the body to get rid of its waste. 



KTJESING 

Why should mothers nurse their children? 

First, because there is no perfect substitute for 
good breast-feeding. Secondly, statistics show that 
the mortality of bottle-fed infants during the first 



NUKSINa 45 



year is fully three times as great as, that of those 
who are breast-fed. 

At what period is nursing of greatest importance? 

During the first three or four months, to give the 
child a proper start. At this time of life the mor- 
tality is highest and artificial feeding is most difficult. 

When should maternal nursing not he attempted? 

If the mother has or has had tuberculosis or any 
other serious chronic disease, or is herself in very 
delicate health, she should not try. She is likely soon 
to fail in nourishing her child, and the attempt may 
do herself much harm as well as injure the child. 

How often should infants he nursed during the 
first two days of life? 

Usually only four or ^yo times daily, since there 
is very little milk secreted at this time. 

When does the milk come in ahundance ? 
Usually on the third day, sometimes not until 
the fourth or fifth or even the ninth or tenth day. - 

Should the infant he fed anything additional dur- 
ing the first two days? 

Usually not ; if much food were necessary, we 
may be sure Mature would have provided it. Water, 
however, should be given regularly. 



46 THE CAEE AND FEEDING OF CHILDEEN 

How frequently should an infant he nursed dur- 
ing the first weeTcf 

After the third day, every three hours during the 
day and twice during the night. The frequency 
during the entire first year is given in the following 
tahle : 



Period. 


Nursings in 
24 hours. 


Interval by day. 


Night nursings 

(6 P.M. to 6 A.M.) 


1st and 2nd day .... 

3 days to 2 weeks. . . 
2 weeks to 4 months 

4 to 7 months 

7 to 12 months 


4 

7 
7 
6 
5 


6 hours. 
3 " 
3 " 

3 " 

4 " 


1 

2 
2 
1 




How long should the child he Tcept at the hreast 
for one nursing? 

'Not over twenty minutes. 

Should the child tahe hoth hreasts at one nursing? 
If the milk is very abundant one breast may be 
sufficient, otherwise both breasts may be taken. 

What are the important things to he attended to 
in nursing? 

First, regularity; it is just as important as in 
the case of bottle-feeding. Secondly, the nipples 
should be kept clean by being washed after every 
nursing. 



NUESINa 47 



What should he the diet of a nursing mother? 

She should have a simple but generous diet with 
plenty of fluids ; three regular meals may be given, 
and gruel, milk, or cocoa at bed-time and sometimes 
between meals. She may take eggs, cereals, most 
soups, and nearly all vegetables, avoiding sour fruits, 
salads, pastry, and most desserts. Meat should not 
be taken more than twice daily, and in many cases 
but once. She should take but little tea or coffee, 
and ordinarily no wine or beer. 

Are fruits liJcely to disturb a nursing infant? 
Sour fruits in some cases may do so, but sweet 
fruits and most cooked fruits are useful. 

What else is important in the life of the nursing 
mother? 

She should lead a simple natural life; should 
have regular out-of-door exercise, preferably walking 
or driving, as soon after her confinement as her con- 
dition will permit. She should have regular move- 
ments from the bowels daily. She should be as free 
as possible from unnecessary cares and worry; her 
rest at night should be disturbed as little as possible ; 
she should go to bed early and lie down for at least 
one hour in the middle of the day. 



48 THE CARE AND FEEDING OF CHILDREN 

Does the nervous condition of the mother affect 
the milhf 

Very mucli more tlian her diet ; worry, anxiety, 
fatigue, loss of sleep, household cares, social dissipa- 
tion, etc., have more than anything else to do with 
the failure of the modern mother as a nurse. Uncon- 
trolled emotions, grief, excitement, fright, passion, 
may cause milk to disagree with the child ; at times 
they may excite acute illness, and at other times they 
may cause a sudden and complete disappearance of 
the milk. 

Does menstruation affect the milk? 

In nearly all cases the quantity of milk is less- 
ened during the period so that the infant is not satis- 
fied and may not gain in weight. In many cases the 
quality of the milk is also affected to such a degree as 
to cause slight disturhances of digestion, like restless- 
ness, colic, or some derangement of the bowels. In 
a few, attacks of acute indigestion are excited. 

7s the return of menstruation a reason for stop- 
ping nursing? 

ISTot usually; as a rule both functions do not go 
on together. But if the child is gaining regularly in 
weight between the periods, nursing may be con- 
tinued indefinitely, although it may be well to feed 



NUKSING 49 



the infant wholly or in part during the first day or 
two that the mother is -unwell. 



WJiat symptoms indicate that a nursing infant is 
well nourished? 

The child has good color, sleeps two or three 
hours after nursing, or, if awake, is quiet, good-na- 
tured, and apparently comfortahle. It has normal 
movements of the howels and gains weight steadily. 

What symptoms indicate a scanty milk supply 
and that an infant who is nursing is not properly 
nourished? 

It does not gain and may even lose in weight. It 
no longer exhibits its usual energy and playfulness, 
but is either listless and indifferent or cross, fretful 
and irritable, and is apt to sleep poorly. It grows 
pale and anaemic and its tissues become soft and 
flabby. When the milk is scanty it will often nurse a 
long time at the breasts, sometimes three quarters 
of an hour, before stopping. At other times it may 
take the breast for a moment only, and then turn 
away in apparent disgust. The only sure way of 
telling how much milk a child is getting is to weigh it 
before and after nursing, four or ^Ye times a day; 
the child need not be undressed for this purpose. 



50 THE CARE AND FEEDING OF CHILDREN 

What should he done in such cases? 

This depends "apon the severity of the symptoms 
and how long they have lasted. If the child has made 
no gain for several weeks, or is losing weight, im- 
mediate weaning will probably be necessary; in 
any case, other food in addition to the breast milk 
should be given at once. One may alternate the nurs- 
ing and the bottle-feeding and increase the number 
•of bottle-feedings as may be indicated by the results, 
or still better nurse as before and give a smaller bot- 
tle-feeding after the child has taken the breast. A 
:scanty secretion is likely to be still further reduced 
by lessening the number of nursings, while more 
frequent nursings tend to increase the flow. 

Is there any objection to a hahy being partly 
nursed and partly fed? 

iN'one whatever; it is often better from the out- 
set to feed the baby during the night, in order not 
to disturb the mother's rest. If the mother has only 
milk enough for two or three nursings a day, this 
should be continued so long as her milk agrees with 
the baby. Even a small amount of good breast milk 
greatly improves a child's nutrition. 

What symptoms indicate that the mother s milk 
disagrees with the child? 

This should be carefully distinguished from tne 



NURSING 51 



more common condition of hunger due to scanty 
milk. If the milk disagrees, the child suffers from 
almost constant discomfort ; sleeps little and then rest- 
lessly, cries a great deal, belches gas from the stom- 
ach, and passes much by the bowels, or if not passed, 
the gas accumulates and causes abdominal distention 
and colicky pain. There may be vomiting, but more 
often the trouble is intestinal. Sometimes the bowels 
are constipated, but usually the movements are fre- 
quent, loose, green, contain mucus and are passed 
with much gas. 

What should he done under these circumstances? 

If the symptoms have persisted for two or three 
weeks and the child is not gaining in weight, there 
is little chance of improvement, and the child should 
be taken from the breast at once. If there is some 
gain in weight, one may try for a little longer, en- 
deavoring to improve the mother's milk by rest, 
fresh air, careful diet, etc. However, one should 
realize that the trouble is nearly always with the 
milk, not with the child. 

What changes should he made if a nursing infant 
habitually vomits f 

If this occurs soon after nursing, the infant has 
usually taken too much; the time of nursing should 



52 THE CAEE AXD FEEDING OF CHILDKEN 

be shortened or only one breast given. Cursing 
elioiild be interrupted, and the child placed npright 
to enable him to get rid of the gas in the stomach. 
If the vomiting occurs some time after nursing and 
is repeated, it is a sign of indigestion ; often the milk 
is too rich in fat. The intervals between nursings 
should be lengthened to three and a half or even four 
hours : the breast milk may be diluted by giving one 
or two tablespoonfuls of plain boiled water, or barley- 
water, five or ten minutes before nursing ; the mother 
should eat less hearty food, especially less meat. If 
the child is thriving and gaining regularly in weight 
the vomiting will in most cases gTadually improve 
with the changes in regime mentioned; but if the 
child is losing weight weaning is usually advisable. 

What should he done if the infant has frequent 
hahitiial colic? 

The mother should take more out-of-door exer- 
cise, eat less meat and seek to control her emotions ; 
all causes of worry should be removed. If the con- 
stipation which accompanies this condition is re- 
lieved, the colic will usually disappear also. It is 
often useful to increase the interval between feedings. 

Ca7i constipation in a nursing infant he con- 
trolled through the mothers milh? 

Only to a limited extent. It is important that 



WEANING 53 



the mother's bowels be regular and her digestion good. 
An increase in the meat and milk of her diet is some- 
times beneficial. 

Should a mother with a cold continue to nurse 
her hahy? 

The danger of infecting the child while nursing 
is considerable. Many common colds are very con- 
tagious and these often have serious consequences in 
young infants. It is not necessary to stop nursing, 
but while nursing the mother should cover her 
mouth and nose ^\ th a handkerchief, and on no 
account should she kiss the infant or cough or sneeze 
while nursing. 

WEANING 

At what age should the child he weaned from 
the breast f 

Usually weaning should be begun at nine or ten 
months by substituting one feeding a day for one 
nursing, later two feedings, and thus gradually the 
child is to be taken from the breast altogether. 

What is the principal reason for weaning earlier? 

The most important one is that the child is not 
thriving— not gaining in weight nor progressing nor- 
mally in development. Serious illness of the mother, 
or pregnancy, may make weaning necessary. 



54 THE CAEE AND FEEDING OF CHILDEEN 

At ivliat age should the weaning he completed? 

Generally at one year. In summer it may some- 
times be advisable to nurse an infant a little longer 
rather than wean in warm weather; but even then 
the dangers of weaning are much less than those of 
continuing to nurse, as is so often done, after the 
milk has become very scanty and poor in quality. 

When should a child ivho is lueaned from the 
hreast he taught to drinh from the cup, and when 
to take the hottlef 

If weaning is done as early as the eighth or ninth 
month it is better to give the bottle ; if from the tenth 
to the twelfth month the infant ' should be taught to 
drink or be fed with a spoon. 

How may some difficulties in weaning he over- 
come? 

By feeding every nursing infant once a day or 
by giving it water regularly from a feeding-bottle. 
It then becomes accustomed to the bottle. This is a 
matter of gTeat convenience during the whole period 
of nursing when the mother or nurse may from neces- 
sity be away from the child for a few hours; when 
more feedings are required at the time of weaning 
the child does not object. 



WEANING 55 



When should a child he weaned from the bottle? 

With children who are not ill, weaning from the 
bottle should invariably be begun at the end of the 
first year, and after a child is thirteen or fourteen 
months old the bottle should not be given except at 
the night feeding. 

7s there any objection to the child's taking the 
bottle until it is two or three years old? 

There are no advantages and some serious objec- 
tions. Older children often become so attached to 
the bottle that only with the greatest difficulty can 
they be made to give it up. Frequently they will 
refuse all solid food, and will take nothing except 
from the bottle so long as it is given, and when finally, 
at three or four years, it is taken away, they will 
not touch milk during the rest of their child- 
hood. The difficulty is here that children form the 
^^bottle habit.'' This habit is troublesome, unneces- 
sary, and should by all means be prevented. An 
exclusive diet of milk for children of two or three 
years often results in anasmia and malnutrition. 

How should one train a child to do without the 
bottle? 

This is usually easy if it is begun early. The 
milk should be poured into a tiny glass or cup and 



56 THE CAEE AND FEEDINa OF CHILDEEN 

little by little the child is taught to drink or to take 
food from a spoon; at first only a small portion of 
the food is taken in this way, the balance being given 
from the bottle ; but in a few weeks the average in- 
fant learns to drink from a cup without difficulty. 

If the child has been allowed to have the bottle 
until he is two or more years old, the only effective 
means of weaning is through hunger. The bottle 
should be taken away entirely, and nothing allowed 
except milk from a cup until the child takes this 
willingly. Sometimes a child will go an entire day 
without food, occasionally as long as two days, but 
one should not be alarmed and yield. This is a mat- 
ter of the child's will, not his digestion, and once 
he has been conquered there is seldom any further 
trouble. As soon as a child has learned to drink his 
milk from a cup, cereals and other solid foods may 
gradually be added to the diet. The educational 
value of such training is not the least important con- 
sideration. 

Can a hdby just iceaned take cow's milk of the 
same proportions as one of the same age lulio has had 
coivs milk from birth? 

Very rarely ; to give a baby who has had nothing 
but the breast from birth, plain cow's miU^, or even 
that milk which a bottle-fed baby of the same age 



WEANING 57 



miglit take, is almost certain to cause indigestion. 
The change in the food is quite a marked one, and 
should be made gradually by beginning with a weak 
milk and increasing its strength as the baby becomes 
accustomed to take cow's milk. 

WhoA would he the proper proportions for an in- 
fant weaned at four or five months ? 

About the same as for a healthy bottle-fed infant 
of two months; the quantity of course should be 
larger. The food can in most cases be gradually in- 
creased so that in two or three weeks the usual 
strength for the age can be taken. 

What would he the proper proportions for an in- 
fant weaned at nine or ten months? 

About the same as for a bottle-fed infant at four 
or five months, to be increased as indicated above. 

Will not a child lose in iveight ivhen placed upon 
so low a diet? 

Very often it will do so for the first week or two, 
but after that will gain quite regularly; the acute 
indigestion, however, which generally accompanies 
the use of stronger milk will, in most cases, cause a 
greater loss. 



58 THE CARE AND FEEDING OF CHILDEEN 
ARTIFICIAL FEEDING 

What foods contain all the elements present in 
mother s milk? 

The milk of other animals, — cow's milk heing the 'i 
only one which is available for general use. 

Is it not possible for infants to thrive upon other 
foods than those containing fresh milk? 

They may do so for a time, hut never perma- 
nently. The long-continued use of other foods as 
the sole diet is attended with great risk. 

What are the dangers of such foods f 
Frequently scurvy is produced, and in other cases 
simply a condition of general malnutrition, — the 
child does not thrive, is pale, and its muscles are soft 
and flabby. 

THE SELECTION AND CAHE OF MILK USED FOR INFANT 
FEEDING- 

What are the essential points in milk selected for 
the feeding of infants? 

That it comes from healthy cows, is handled only 
by healthy persons, and that it is clean and fresh. 

Is it not important to select a rich milk? 
By no means ; in fact the very rich milk of highly 
bred Jerseys and Alderneys has not been found nearly 



THE SELECTION" AND CARE OF MILK 59 

SO satisfactory in infant feeding as that from some 
other herds, such, for example, as the common ^^grade 
cows." 

Which is the tetter^ milk from one cow or the 
mixed milk of several cows? 

The mixed, or ^^herd milk,'' is usually to he pre- 
ferred, since it varies little from day to day; while 
that from a single cow may vary considerably. 

How fresh is it important that cow's milk should 
he for the best results in infant feeding? 

This depends very much upon the season, and 
how carefully milk is handled. As ordinarily han- 
dled at the dairy and in the home, milk should not 
be used for infants in winter after it is forty-eight 
hours old ; in summer not after it is twenty-four hours 
old, and it may be unsafe in a much shorter time. 
When handled with especial care milk may be safe 
for a longer time. 

What are the two essentials in handling milkf 
1. That it be kept clean and free from contami- 
nation. This necessitates that cows, stables, and 
milkers be clean, and that transportation be in sealed 
bottles ; also that those who handle the milk are them- 
selves healthy and do not have or come in contact with 
any contagious disease. All milk-pails, bottles, cans, 
and other utensils with which the milk comes in con- 



60 THE CARE AND FEEDING OF CHILDREN 

tact should be sterilized shortly before they are used, 
by steam or boiling water. 

2. That it be cooled immediately after leaving 
the cows, and kept at as low a temperature as poss^ 
ble; to be efficient this should not be above 50° T. 

Milk produced under hygienic conditions and 
handled with special care is sold in bottles in 
most cities under the name of '^certified/' or ^'^guar- 
anteed/' milk. When available such milk should be 
used for infants. Of course the extra care bestowed 
in its production and transportation increases the cost 
of the milk, but the best will usually be found in the 
end to be the cheapest. 

How should milk he handled in the home ivheii 
obtained fresh from the coivsf 

That to be used for infants should be strained 
through a thick layer of absorbent cotton or several 
thicknesses of cheese-cloth into quart glass jars or 
milk bottles which should be covered and cooled im- 
mediately, best by placing the bottles quite up to 
their necks in ice water or cold spring water, where 
they should stand for at least half an hour. That 
required for children who take plain milk may now 
be poured into half-pint bottles, stoppered with cot- 
ton, and put in the ice-chest, or the coolest place pos- 
sible. This first rapid cooling is very important and 



THE SELECTION AND CAEE OF MILK 61 

adds mncli to the keeping qualities of the milk. Milk 
loses its heat very quickly when cooled in water, but 
very slowly when it is simply placed in a cold room. 
After standing four or ^ye hours the top-milk may 
be removed ; after twelve to sixteen hours the cream 
may be removed. 

Hoiu should milk he handled ivhen bottled milk 
is purchased? 

It should be cooled as just described, as its tem- 
perature is usually somewhat raised during trans- 
portation. If it has been bottled at a dairy, the cream 
or the top-milk may be removed after an hour or 
two. 

Hoiv should milk and cream he handled when 
they are purchased in hulk? 

Such milk should never be used for infants when 
it is possible to obtain bottled milk, as it is much 
more liable to contamination. It should be poured 
at once into sterilized bottles and kept in the coolest 
place possible. 

What are the important things to he secured in 
nursery refrigerators f 

Absolute cleanliness is essential ; hence the inner 
portion should be of tile, glass or metal. Those made 
entirely of metal are often unsatisfactory as in them 



62, THE CAEE AND FEEDING OF CHILDKEN 

the ice melts very quickly. If the ordinary metal re- 
frigerator sold is encased in a wooden box, we have 
the best form. Another easy way of securing the 
same result is to make for the refrigerator a covering 
or "cosey" of felt or heavy quilting, which can be 
easily removed when wet or soiled. 

The compartments of the refrigerator should be 
so arranged that the bottles of milk are either in 
contact with the ice or very near it. The supply of 
ice should be abundant. Often the amount of ice is 
60 small, and the bottles so far away, that the tem- 
perature of the milk is never below 60° or 65° F. 
To be really effective a refrigerator should have a 
temperature where the milk is placed of not over 
50° F. The temperature should be tested with the 
nursery thermometer from time to time to ascertain 
what results are being obtained. Spoiled milk owing 
to a faulty refrigerator is not rarely a cause of acute 
illness among infants. Next to the feeding-bottles it 
is the one thing in the nursery which should receive 
the closest attention. 

Are there any objections to the use of vacuum 
(thermos) bottles for keeping the milk warm or 
coldf 

They are often useful to keep milk cold while 
traveling. They should not be used to keep milk 



THE MODIFICATION OF COW'S MILK 63 



warm as for night feedings. Milk which has been 
kept for several hours at the feeding temperature is 
often so changed as to make the baby ill. 

THE MODIFICATION OF COw's MILK 

What is meant hy the modification of cow's milh? 
Changing its proportions so that it can be more 
easily digested. 

Is it possible to modify cow's milh so as to maJce 
it a perfect substitute for mother s milh? 

It is not. Although we can modify cow's milk 
so that the great majority of infants can digest it 
and thrive on it, it must be remembered that there 
are differences which cannot be wholly overcome. 
There are certain peculiar qualities in mother's milk 
which cow's milk does not possess. 

How is this milh, whose proportions have heen 
'changed, distinguished from the unchanged milh? 

The changed milk is usually called "modified 
milk"; the original unchanged milk is known as 
"plain milk," "whole milk," "straight milk," or is 
referred to simply as "milk." 

What are the principal differences between cow's 
milh and mother s milhf 

Cow's milk has only a little more than half as 



64 THE CAEE AND FEEDING OF CHILDREN 

much sugar; it has nearly three times as much pro- 
tein and salts; its protein and fat are different and 
the fat much more difficult of digestion. 

Are there any other important things to he con- 
sidered? 

Yes; mother's milk is always fed fresh and is 
practically sterile. Cow's milk is generally kept 
twenty-four hours and sometimes much longer. It 
is to a greater or less degree contaminated by 
dirt and germs^ the number of which increases rap- 
idly (1) with the age of the milk; (2) in pro- 
portion to the amount of dust or dirt which enters it ; 
(3) with any increase in the temperature at which 
the milk is kept. 

It is just as important for success in infant feed- 
ing that these conditions receive attention as that 
the proportions of the different elements of the milk 
are right. 

Is the addition of lime water necessary ? 

For some infants with feeble or disturbed diges- 
tion the addition of one ounce, sometimes as much as 
two ounces, of lime water to each twenty ounces of 
the food is useful. Its routine use for all infants is 
unnecessary. 



THE MODIFICATION OF COW'S MILK 65 

__ 

" How is the sugar best increased? 
By adding sugar to the food; three level table- 
spoonfuls of milk sugar to each twenty ounces of 
food will give the proper quantity for the first three 
or four months. This will make the proportion about 
the same as in mother's milk. 

H 010 should the sugar he prepared? 

Simply dissolved in boiled water ; if the solution 
is not clear, or if there is a deposit after standing, 
it should be filtered by pouring through a layer of 
absorbent cotton, half an inch thick, which is placed 
in an ordinary funnel. 

Will not cane (granulated) sugar answer as tvell 
as milk sugar? 

Most infants appear to do quite as well when 
cane sugar is used. It has the advantage of being 
much cheaper. A good grade of milk sugar is some- 
what expensive, and cheap samples are apt to contain 
impurities. Moreover, there are some infants in. 
whom diarrhoea is excited if the usual amount of 
milk sugar is given, yet who bear cane sugar very- 
well. There are also others who do better when milk 
sugar is used. 

If cane sugar is used, what amount should he 
added? 

Cane sugar is heavier than milk sugar ; two level 



'66 THE CARE AND FEEDINa OF CHILDREN 

tablespoonfuls to each twenty ounces of the food is 
as much as is usually desirable. This is equivalent 
to three level tablespoonfuls of milk sugar. 

May any other sugar he usedf 

Maltose ^ (malt sugar) has the advantage of being 
very easily digested; when part of the sugar 
given is maltose, many children gain more rapidly 
in weight than when only milk sugar or cane sugar 
is used. 

Has maltose any other advantages? 
It is somewhat more laxative than other sugars; 
it is therefore useful when there is constipation. 

Are there any disadvantages attending the use 
of maltose? 

It is not well borne if the bowels are loose, nor 
should it be used for children who vomit frequently 
or habitually. 

1 Dry preparations of maltose available are ''dextri-maltose" 
(Mead Johnson & Co.), and '^nahrzucker" (Soxhlet, Germany). 
Liquid preparations are Loeflmid's or Borcherdt's "malt soup 
extract"; somewhat less expensive bu!. rehable is the "neutral 
maltose" (Maltzyme Co., Brooklyn). 

For an infant six months old from, two teaspoonfuls to two 
tablespoonfuls of any of these preparations may be added to the 
food for the day, replacing a similar quantity of milk sugar. 

MeUin's food and malted milk also contain a large percentage 
of maltose. 



THE MODIFICATION OF COW'S MILK 67 

is not the purpose of the sugar to sweeten the 
food in order to make it palatable? 

Not at all; although it does that, its real use is 
to furnish one of the essential elements needed for 
the growth of the body, and the one that is required 
by young infants in the largest quantity. 

How do we hnow that this is so? 

By the fact that in good breast milk the amount 
of sugar is greater than that of the fat, protein, and 
salts combined. 

We have seen that cow's milk has nearly three 
times as much protein {curd) and salts as mother s 
milk. How are these to he reduced? 

By diluting the milk. 

To what extent is dilution desirable? 

For the early weeks the milk should be diluted 
twice; after three months diluting once is usually 
sufficient. 

When cow's milk has been diluted in this way does 
it not contain much less fat than mother s milk ? 

This is quite true ; but on account of the difference 
in the two fats it is about as much as the average 
child can digest. 

What is cream? 

Cream is often spoken of as if it were the fat in 
milk. It is really the part of the milk which con- 



68 THE CARE AND FEEDING OF CHILDREN 

tains most of the fat. It differs from milk chiefly 
in containing much more fat. 

In what ways is cream now obtained? 

(1) By skimming, after the milk has stood nsii- 
ally for twenty-four hours; this is known as ^^grav- 
ity cream." (2) By an apparatus called a separator; 
this is known as ^^centrifugal cream" ; most of 
the cream now sold in cities is of this kind. The 
richness of any cream is indicated by the amount of 
fat it contains. 

The usual gravity cream sold has from 16 to 20 
per cent fat. The cream removed from the upper 
part (one fifth) of a bottle of milk has about 16 per 
cent fat. The usual centrifugal cream has 18 to 20 
per cent fat. The heavy centrifugal cream has 35 
to 40 per cent fat. 

Is cream more digestible than milJcf 
For most infants it is much less so; serious dis- 
turbances of digestion are often caused by cream 
when used in any considerable amount. 

What is top-milk f 

It is the thin cream removed from the top of a 
bottle of milk after standing a few hours. 

By a 7-per-cent top-milk is meant one which con- 
tains 7 per cent fat. ^N'o richer top-milk should be 
used in infant feeding. 



FOOD FOE HEALTHY INFANTS 69 

How can 7-per-cent top-milk he obtained? 

From a good average milk^ by removing tlie upper 
sixteen ounces, or one-half. 

From a rich Jersey milk, by removing the upper 
twenty-two ounces, or about two-thirds. 

When and how should top-milh he reynoved? 

If milk fresh from the cow, or before the cream 
has risen, is put into bottles and rapidly cooled, the 
top-milk may be removed in as short a time as four 
hours. In the case of bottled milk it makes little 
difference if it stands a longer time, even until the 
next day. The best means of removing it is by a 
small cream-dipper ^ holding one ounce ; although it 
may be taken off by a spoon or siphon. It should not 
be poured off. 

FOOD FOB HEALTHY II^FANTS ^ 

In deciding upon the food for young infants, ivhat 
are the different points to he determined? 

(1) Amount of milk and sugar required for 
twenty-four hours. 

^ Obtained from any of the Walker-Gordon milk laboratories, 
from James Dougherty, No. 411 West 59th Street, New York, 
and from many druggists. Price, 20 cents. 

2 The directions and formulas given in the following pages are 
intended only for guidance in feeding children who are not suf- 
iering from any special disturbance of digestion; directions for 
such conditions are given in a later chapter. 



70 THE CARE AND EEEDINa OF CHILDEEN 

(2) The volume of the food to be given in twenty- 
four hours ; this will of course include the milk and 
the water or other diluent added. 

(3) The number of feedings into which the daily 
food is to be divided, and the intervals at which the 
food is given. 

Which is the most important? 

The quantity of milk and sugar which are given. 
This must be sufficient for the needs of the body, 
which are, (1) to produce heat; (2) to repair waste; 
(3) to provide for growth. 

What happens if too little food is given? 

Since heat and waste must first be provided for, 
it is growth which suffers. There is not a proper 
gain in weight. 

What happens if too much food is given? 

The excess becomes a burden to the child and 
hinders his progress. If too much food is continued 
for any length of time, serious disturbances of di- 
gestion and nutrition are apt to follow. It is there- 
fore very important to give enough^ but also to give 
no more than the child actually needs. 

Hoiv do we Jcnow how much food a healthy child 
needs? 

This depends upon several things. Chiefly upon 
his weight, his size and his activity. 



FOOD FOE HEALTHY INFANTS 71 

Is not the age also important f 

It must be considered, but it is not so good a guide 
as the other factors. In feeding by age alone a small 
child is apt to get too much food and a large child too 
little food. A child of three months weighing twelve 
pounds needs more food than a child who is three days 
old and who weighs twelve pounds; and a child of 
three months weighing twelve pounds needs more food 
than one of the same age who weighs but nine pounds. 

Does the child's activity affect Ms need of food? 

This is important and usually not enough con- 
sidered. A laboring man working out of doors re- 
quires much more food than a book-keeper; and a 
lively, active, energetic infant needs more food than 
one who is quiet and placid ; sometimes as much as a 
third or quarter more. This need is shown in the 
child's appetite. 

Is not the appetite of the child then a proper 
guide ? 

This is important and must always be considered,, 
but alone it is a very unreliable guide. For many 
infants will regularly take much more food than they 
need, if it is offered. 

In feeding children with disturbed digestion can 
the same rules he applied? 

Only to a limited degree. For such infants other 



72 THE CAEE AND FEEDING OF CHILDREN 

things must be considered, especially the nature and 
severity of the disturbance of digestion. 

Ah out Jiow much food does a healthy child re- 
quire each day? 

A good average is one ounce of sugar a day, 
and to allow one and one-half ounces of milk 
to each pound of the child's weight ; for example, a 
child of ten pounds would require fifteen ounces of 
milk, one of twelve pounds eighteen ounces, etc. Dur- 
ing the first two weeks of life somewhat less milk 
should be given. 

In feeding healthy children, if the proper amounts 
of milJc and sugar are given, does it matter ichether 
these are diluted much or little? 

It is less essential than the amount of food given, 
but it is important. The body requires a certain 
amount of fiuid daily for the most satisfactory nu- 
trition. 

Too great a dilution of the food makes the volume 
of the feeding too large, overdistends the stomach and 
often produces vomiting. If the dilution is insuf- 
ficient, the child does not usually digest his milk so 
well, and besides he does not receive as much fluid as 
he requires. 



FOOD FOR HEALTHY INFANTS 



73 



Cannot this extra fluid he given hetiveen meals as 
water? 

This is exactly what is done with older children ; 
bnt with infants, especially yonng infants, it is usu- 
ally difficult, and sometimes impossible, to make them 
take any considerable amount of water apart from 
the food. The easiest way is to put the water in the 
food, thus diluting it. 

^Yllat is the simplest luay of modifying milk for 
infant feeding? 

To use whole milk in the amounts required, di- 
luted according to the principles just laid down, 
addins' su£:ar, etc. 



FORMULAS FROM WHOLE MILK (4-PER CENT FAT) FOR THE EARLY 

MONTHS 



Formula. 


I. 


II. 


III. 


IV. 


V. 


VI. 


VII. 


VIII. 


IX. 


Milk oz. 

Sugar '' 

Water " 

Flour . . . tablesp's 


6 

1 

14 




61 

1 

131 




7 

1 

13 




7i 
1 




8 

1 

12 




81 
1 




9 

1 

11 




91 

1 

101 




10 

1 

10 

1 




20 


20 


20 


20 


20 


20 


20 


20 


20 



/' 



Note. — The sugar is 1 ounce by weight; this is equivalent to 
3 level tablespoonfuls of milk sugar or maltose, and 2 level 
tablespoonfuls of granulated sugar. 

The flour may be barley, oat, rice or wheat flour, or arrowroot 
'cooked for thirty minutes in part of the water in the formula. 
Level tablespoonfuls should be used. 



74 



THE CAEE AND FEEDING OF CHILDKEN 



How should such formulas as those in the table 
he used? 

Beginning at birth, Formnla I might first be 
given, and the strength of the food increased about 
once a week up to jSTo. V, after that every two weeks 
until 'No. IX is reached. 

Such a formula as No. IX will be reached by an 
average healthy infant at about three months of age. 
After this the next group of formulas may be used, 
but the increase should be made more slowly, about 
once a month up to Xo. XII, then about every two 
months, reaching Xo. XIV at about ten months. 
This may be continued up to twelve months. 



FORMULAS FROM WHOLE MILK FOR THE LATER MONTHS 



Formula. 


IX. 


X. 


XI. 


XII. 


XIII. 


XIV. 


Milk oz. 

Sugar '* 

Water " 

Flour tablesp's 


10 
1 

10 
1 


11 
9 


12 

8 
1* 


13 


14 
2 


15 

h 

5 
3 




20 


20 


20 


20 


20 


20 



If top-milk instead of ivhole milk were used, what 
changes in these formulas would he necessary? 

One should use from one-third to one-fourth less 
milk in each of the formulas, otherwise they are the 
same. 



FOOD FOR HEALTHY INFANTS 



75 





FORMULAS FROM 7-PER CENT TOP-MILK 


In Formula No, I. 


use 


4 


ounces top 


milk in 20 ounces. 




II. 




41 


u u 






" III. 




5 








IV. 




5^ 








V. 




6 








" VI. 




Qh 








" VII. 




7 








" VIII. 




n 








" IX. 




8 








X. 




9 








" XI. 




9t 








" XII. 




10 








" XIII. 




101 






it ( 


" XIV. 




11 







For the first two or three weeks it is well to use 
the formulas of the whole milk series and then those 
of the top-milk series beginning with 'No. III. The 
food is increased in strength at about the same inter- 
vals in both series of formulas. 

After No. XIV instead of taking the upper 16 
ounces, one may take off 20, and use 12 ounces of 
this in 20 of food ; then take off 24 and use 13 ounces 
of this in 20 of food; then use the whole milk, 15 
ounces in 20 of food which is the same as No, XIV 
of the whole milk series. 



Under what circumstances are these top-milk for- 
mulas to he advised? 

For strong, healthy children with good digestion. 
Such children are usually able to take food containing 



76 THE CARE. AND FEEDING OP CHILDREN 

higher fat than in the formulas from whole milk and 
thrive better when it is given. 

Under what circumstances are formulas from 
whole milk to he advised? 

For most infants except the robust class just de- 
scribed. 

There is a great advantage in having the two dif- 
ferent groups of formulas for use with different types 
of children. 

Under what circumstances should top-milk formu- 
las not he used? 

They should not be given to infants with feeble 
digestion or to those suffering from acute or chronic^ 
disturbances of digestion, especially if vomiting is 
present. 

How often should a young hahy he fed? 

Every three hours by day and twice at night (be- 
tween 6 p. M. and 6 a. m.), or seven times in the 
twenty-four hours. At three months one of the feed- 
ings between 6 p. m. and 6 a. m. may be omitted 
and but six feedings given in the twenty-four hours. 

Why should not a child he fed more frequently? 

It takes the stomach from two to two and a half 
hours to digest a feeding of cow's milk, even when 
much diluted. When the food is made stronger, more 
time is required for digestion. If the meals are too 



FOOD FOR HEALTHY INFANTS 



77 



near together the second one is given before the first 
has been digested; vomiting and indigestion may re- 
sult. The meals should be far enough apart to give 
the stomach a little time for rest before the next feed- 
ing. A common cause of indigestion^ especially 
vomiting, is too frequent feeding. 

The number of feedings in twenty-four hours, the 
quantity for a single feeding and the daily quantity 
are given in the following table. 

SCHEDULE FOR HEALTHY INFANTS FOR THE FIRST TEAR 



Age. 


Interval 

between 

meals 

by day. 


Night 
feedings 
(6 p. M. to 

6 A. M.) 


No. of 

feedings 

in 24 

hours. 


Quantity 

for 

one 

feeding. 


Quantity 

for 

24 

hours. 


2d to 7th day 

2d and 3d weeks .... 

4th to 6th week 

7th week to 3 mos.. . 

3 to 5 months 

5 to 7 months 

7 to 12 months 


Hours. 

3 
3 
3 
3 
3 
3 
4 


2 

2 
2 
2 

1 
1 

1 


7 
7 
7 
7 
6 
6 
5 


Ounces. 

1 -2 

2 -31 

3 -4 
3i-5 
41-6 
5^6^ 
7-81 


Ounces. 

7-14 
14-24 
21-28 
25-35 
27-36 
33-39 
35-43 



This schedule gives the averages for healthy chil- 
dren. The smaller quantities are those required by 
small children whose digestion is not very vigorous. 
The larger quantities are those required by large chil- 
dren with strong digestion; in very few cases will 
it be advisable to go above these figures. 



78 THE CARE AND FEEDING OF CHILDREN 

The interval is reckoned from the beginning of 
one feeding to the beginning of the next one. 

Under what circumstances should the interval 
between the feedings he lengthened'? 

When there is gastric indigestion as shown bj 
habitual vomiting or the regurgitation of food long 
after the bottle is finished ; also when the appetite is 
very poor so that the infant regularly leaves some of 
its food. 

When should the interval between the feedings 
be shortened? 

This is done much too frequently; it is rarely 
advisable to feed any infant, except one seriously ill, 
oftener than the time put down in the schedule. 

In the series of formulas given in the table the 
quantities are mentioned for making only twenty 
ounces of food. How should it be prepared when 
more than this quantity is needed? 

It is equally convenient to make up 25, 30, 35, 
or 40 ounces at a time. To make 



25 ounces of any formula add one quarter more of each ingredient 
30 " " " " one haK 

35 " " " " three quarters " " " 

40 " " " " as much " " " 



PEEPARATION OF COW'S MILK AT HOME 79 



Thus, if using Eormula V one would take 

to make to make to make 

25 ounces. 30 ounces. 35 ounces. 

Milk ... 10 ounces. Milk .... 12 ounces. Milk .... 14 ounces. 

Sugar., li " Sugar.... H " Sugar.... 1| " 

Water.. 15 " Water... 18 " Water... 21 

The amount of water need not be calculated in 
any case, but after measuring carefully the other in- 
gredients enough water should be added to bring the 
total up to the amount required. 



PREPAEATIOI^ OF COw's MILK AT HOME 



What articles are required for the preparation of 
cow's milk at home f 

Feeding-bottles, rubber nipples, an eight-ounce 
graduated measuring glass, a glass or agate funnel, 
bottle brush, cotton, alcohol lamp or, better, a Bun- 
sen gas burner, a tall quart cup for warming bottles 
of milk, a pitcher for mixing the food, a wide-mouth 
bottle for boric acid and one for bicarbonate of soda, 
and a pasteurizer. Later, a double boiler for cooking 
cereals will be needed. 

What bottles are to he preferred? 
A cylindrical graduated bottle with a rather wide 
neck, so as to admit of easy washing, and one which 



80 THE CAEE AND FEEDIXO OF CHILDBEN 

contains no angles or corners. A single size holding 
eight ounces is quite sufficient for use during the first 
year. All complicated bottles are bad, being difficult 
to clean. One should have as many bottles in use as 
the child takes meals a day. 

How sliould hoUles he cared for? 

As soon as they are emptied they should be rinsed 
with cold water and allowed to stand filled with water 
to which a little bicarbonate of soda has been added. 
Before the milk is put into them they should be thor- 
oughly washed with a bottle brush and hot soap- 
suds and then boiled or placed for ten minutes in 
boiling water. 

What sort of nipples sliould he used? 

Only simple straight nipples which slip over the 
neck of the bottle. Those with a rubber or glass tube 
are too complicated and very difficult to keep clean, 
tipples made of black rubber are to be preferred. 
The hole in the nipple should not be so large that 
the milk will run in a stream, but just large enough 
for it to drop rapidly when the bottle with the nip- 
ple attached is inverted. 

How sliould nipples he cared for? 
JSTew nipples should be boiled for ^yq minutes; 
"^ut it is unnecessary to boil them every day, as they 



PEEPAEATION OF COWS MILK AT HOME 81 

soon become so soft as to be almost useless. After 
usingj nipples should be carefully rinsed in cold water 
and kept in a covered glass containing a solution of 
borax or boric acid. At least once a day they should 
be turned inside out and thoroughly washed with soap 
and water. 

What sort of cotton should he used? 

The refined non-absorbent cotton is rather better 
for stoppering bottles, but the ordinary absorbent cot- 
ton will answer every purpose. 

Which is better, the Bunsen turner or the alcohol 
lamp f 

If there is gas in the house, the Bunsen burner 
is greatly to be preferred, being cheaper, simpler, and 
much safer than the alcohol lamp. If the lamp is 
used, it should stand upon a table covered with a 
plate of zinc or tin, or upon a large tin tray. The 
safest thing to use in the nursery is the small electric 
heater. 

Give the directions for preparing the food ac- 
cording to any of the above formulas. 

The nurse's hands, bottles, tables, and all utensils 
should be scrilpulously clean. If flour is used in 
the food, this is cooked in water for twenty minutes 
and then sufficient boiled water added to bring the 



82 THE CAEE AND FEEDING OF CHILDEEN 

total quantity up to that called for in the formula. 
When this has cooled, the milk and sugar should be 
added and the whole mixed in a pitcher. The food 
for twenty-four hours is always to be prepared at 
one time. The amount needed for each feeding is 
put in a separate bottle; bottles are then stoppered 
with cotton and placed at once in the ice-box or the 
food is first pasteurized according to directions given 
elsewhere. 



DIRECTIONS FOE FEEDIN"G INFANTS 

How should the bottle he prepared at feeding 
time f 

It should be taken from the ice chest, and warmed 
by standing in warm water which is deep enough to 
cover the milk in the bottle ; it should then be thor- 
oughly shaken and the nipple adjusted; the nurse 
should see that the hole in the nipple is not too large 
nor too small. 

How may the temperature of the milk he tested? 

^ever by putting the nipple in the nurse's mouth. 
Eefore adjusting the nipple, a teaspoonful may be 
poured from the bottle and tasted, or a few drops 
may be poured through the nipple upon the inner 
surface of the wrist, where it should feel quite warm 



DIEECTIONS FOR FEEDING INFANTS 83 

but never hot; or a thermometer may be placed in 
the water in which the bottle stands. A dairy ther- 
mometer should be used, and the temperature of the 
water should be between 9S° and 105° F. 

What is a simple contrivance for Iceeping the 
milk warm during feeding? 

A small flannel bag with a draw string may be 
slipped over the bottle. 

In what position should an infant taTce its bottle f 
For the first two or three months it is better, ex- 
cept at night, when it may be undesirable to take the 
infant from its crib, that it be held on the nurse's 
arm during the feeding; later it may lie on its side 
in the crib provided the bottle is held by the nurse 
until it has been emptied ; otherwise a young infant 
readily falls into the bad habit of alternately sucking 
and sleeping, and often will be an hour or more over 
its bottle. 

How much time should he allowed for one feed- 
ing? 

' Not more than twenty minutes. The bottle should 
then be taken away and not given until the next feed- 
ing time. Under no circumstances should an infant 
form the habit of sleeping with the nipple in its 
mouth. A sleepy infant should be kept awake by 



;84 THE CAEE AND FEEDING OF CHILDEEN 

gentle shaking until the food is taken, or the bottle 
should be removed altogether. 

Should an infant he played with soon after feed- 
ing? 

On no account ; such a thing frequently causes 
Tomiting and sometimes indigestion. After feeding 
"the infant may be lifted from his crib, placed over 
the nurse's shoulder and patted for a moment to allow 
him to bring up the air that he has swallowed. He 
•should then be placed in his crib and allowed to lie 
quietly without rocking, being disturbed as little as 
possible either by the nurse, the parents or visitors. 



•GENERAL RTTLES FOE GUIDANCE IN THE USE OF THE 
FOEMIJLAS GIVEN 

It should again be emphasized that these formulas 
are not intended for sick children nor for those suf- 
fering from any marked sjTuptoms of indigestion. 
For such infants special rules are given later. 

What should he the guide in deciding upon a for- 
mula with which to hegin for a child ivho is to he 
artificially fed? 

The age and the weight are of importance, but the 
best guide is the condition of the child's digestive or- 



GENEEAL EULES FOE GUIDANCE 85^ 

gans. One should always begin with a weak formula,, 
particularly, (1) with an infant previously breast 
fed; (2) with one just weaned, as a child who has 
never had cow's milk must at first have weaker pro- 
portions than the age and the weight would seem to 
indicate; (3) with infants whose power of digestion 
is unknown. If the first formula tried is weaker 
than the child can digest, the food can be strength- 
ened every three or four days until the child's capac- 
ity is reached. On the contrary, if the food is made 
too strong at first, an attack of indigestion will 
probably follow. 

How should tJie food he increased in strength? 

The first essential is that it be done very gradu- 
ally; abruptly increasing the food usually causes a 
disturbance of digestion. 

It is never wise to advance more rapidly in 
strengthening the food than from one formula to the 
next one in any of the series given ; with some in- 
fants it is better to make the steps of increase only 
half as great as those indicated. 

How rapidly should the food he increased in 
quantity f 

The increase should not be more than a quarter of 
an ounce in each feeding; never oftener than every 
three days and usually not oftener than once a week. 



86 THE CAEE AND FEEDING OF CHILDKEN 

When should the food he increased? 

In tlie early weeks an increase may be necessary 
every few days; in the later months sometimes the 
same formula may be continued for two or three 
months. It is, however, impossible to give a definite 
rule as to time. One cannot say with any child that 
an increase is to be made every week o^ every two 
weeks. A much better guide is the condition of the 
digestion as shown by the child's appetite, the char- 
acter of the stools, the sleep, and the general disposi- 
tion. 

The signs indicating that the food should be in- 
creased are, that the infant is not satisfied, not gain- 
ing in weight, but is digesting well, i. e., not vomit- 
ing, and having good stools. One should not increase 
the food, however, so long as the child seems perfectly 
satisfied and is gaining from four to six ounces a 
week, even though both the quantity and the strength 
of the food are considerably below the average ; nor 
should the food be increased if the child is gaining 
from eight to ten ounces a week, even if he seems- 
somewhat hungry. The appetite is not always a trust- 
worthy guide. Many infants will habitually take 
more food than they are able to digest and it is not 
safe to give an infant more and more food just be- 
cause he will take it. The purpose should not be 
to see how much food a child can be induced to take. 



GENEEAL EULES FOE GUIDANCE 87 

but to see how well he can be kept. The ultirtiate 
results of overfeeding are serious disturbances of di- 
gestion. 

How can one know whether the strength or the 
quantity of the food should he increased f 

In the early weeks it is well first to increase the 
strength of the food, the, next time to increase the 
quantity, then the strength again, etc. After ' the 
fourth or fifth month, the quantity, chiefly, should be 
increased. 

If a slight disturhance or discomfort occurs after 
the food has been strengthened, is it best to go hach 
to the weaker formula or to persist with the new one ? 

Symptoms of minor discomfort are seen for a day 
or two with many infants after an ordinary increase 
in food; but in most cases an infant soon becomes 
accustomed to the stronger food and is able to digest 
it. If, however, the symptoms of disturbance are 
marked, one should promptly go back to the weaker 
formula. The next increase should be a smaller one. 

Should one he disturbed if for the first two or 
three weeks of artificial feeding the gain in weight is 
very slight or even if there is none? 

'Not as a rule. If the infant does not lose weight, 
is perfectly comfortable, sleeps most of the time, and 



88 THE CARE A^^D FEEDING OF CHILDREN 

does not suffer from any symptoms of indigestion, 
sncli as colic, vomiting, etc., one may be sure that 
all is going well and that the infant is becoming used 
to his new food. As the child's appetite improves and 
his digestion is stronger, the food may be increased 
every few days and very soon the gain in weight will 
come and will then be continuous. If, however, the 
scales are watched too closely and, because there is 
only a slight gain in weight or none at all, the food is 
rapidly increased, an acute disturbance of digestion is 
pretty certain to follow. 

Is not constipation likely to occur if the child is 
on a very weak food? 

It is very often seen and is due simply to the 
small amount of residue in the intestine. But if the 
bowels move once a day, one should not be disturbed 
even when the movements are small and somewhat 
dry. As the food is gradually strengthened, this con- 
stipation soon passes off; while if injections, suppos- 
itories, or cathartics are used to produce freer move- 
ments, the functions of the bowels are likely to be 
disturbed. 

Under what circumstances should the food he re- 
duced? 

Whenever the child becomes ill from any cause 



GENERAL EULES FOE GUIDANCE 89 

whatever, or whenever any marked symptoms of indi- 
gestion arise. 

How may this he done? 

If the disturbance is only a moderate one and the 
food has been made up for the day, one-third may be 
poured off from the top of each bottle just before it 
is given, and this quantity of food replaced by the 
same amount of boiled water. 

If the disturbance is more severe, the food should 
be immediately diluted by at least one-half and at 
the same time the quantity given should be reduced. 

For a severe acute attack of indigestion the regu- 
lar food should be omitted altogether and only water 
given until the doctor has been called. 

// tlie food lias been reduced for a disturbance 
of digestion, Jioiu should one return to the original 
formula f 

While the reduction of the food should be im- 
mediate and considerable, the increase should be very 
gradual. After a serious attack of acute indigestion, 
when beginning with milk again, it should not be 
made more than one-fourth the original strength, and 
from ten days to two weeks should pass before the 
child is brought back to his original food, which 
should be done very gradually. It is surprising how 



90 THE CARE AND FEEDING OF, CHILDEEN 

long a time is required with young infants before 
they completely recover from an attack of acute indi- 
gestion, even though it did not seem to be very severe. 
The second disturbance always comes from a slighter 
cause than the first one. 



KEGULABITY IN FEEDING 

How can a hahy he taught to he regular in its 
Jiabits of eating and sleeping f 

By always feeding at regular intervals and put- 
ting to sleep at exactly the same time every day and 
evening. 

When should regidar training he he gun? 
During the first week of life. 

Should a hahy he waT<:ened to he nursed or fed if 
sleeping quietly? 

Yes, for a few days. This will not be required 
long, for with regular feeding an infant soon wakes 
regularly for its meal, almost upon the minute. 

Should regularity in feeding he Icept up at night 
as well as during the day? 

With a very young infant up to nine or ten 
o'clock; with older infants, only up to six o'clock; 
after that time they should be allowed to sleep as long 



OVERFEEDING 91 



as they will^ and the night feeding not given unless 
they wake for it. 

At what age may a well hahy go without food 
from 10 p. M. to 6 or 7 A. m J 

Usually at three months, and always at five or six 
months. !N^ight feeding is one of the most frequent 
causes of wakefulness and disturbed sleep. 

OVEEFEEDING 

What is meant by overfeeding? 

Giving an infant too much food ; either too much 
at one time or too frequently. Overfeeding, espe- 
cially at night, is the most common of all mistakes 
in artificial feeding. 

Is not an infant's natural desire for food a proper 
guide as to the quantity to he given? 

The appetite of a perfectly normal infant usu- 
ally is ; but overeating is a habit gradually acquired 
and may continue until twice as much food as is 
proper is taken in the twenty-four hours. This habit 
is most frequently seen in infants whose digestion 
is not quite normal ; because of the temporary relief 
from discomfort experienced by taking food into the 
stomach, they often appear to be hungry the greater 
part of the time, especially at night. 



92 THE CARE AND FEEDING OF CHILDREN 

What are the causes of overfeeding f 
The most common one is the hahit of watching 
the weight too closely, and the conviction on the part 
of the mother or nnrse that, because a child is not so 
large nor gaining so rapidly as some other infant 
of the same age^ more food or stronger food should 
be given. 

^Yhat harm results from overfeedingf 
All food taken in excess of what a child can di- 
gest becomes a burden to him. The food lies in the 
stomach or bowels nndigested, ferments, and causes 
wind and colic. When overfeeding is longer con- 
tinued, serious disturbances of digestion are soon 
produced. The infant is restless, fretful, constantly 
uncomfortable, sleeps badly, stops gaining and may 
even lose in weight. Such symptoms may lead to 
the mistaken conclusion that too little food is given, 
and it is accordingly increased, when it should be 
diminished. 

^Yhat are the earliest signs of overfeeding? 

That an infant does not quite finish his bottle. 
If this happens but once in a few days it is not im- 
portant ; but when it occurs with almost every feed- 
ing it is a warning which should be heeded. Under 
■fto circumstances should an infant be coaxed to take 



COMMON MISTAKES IN MILK MODIFICATION 93 

more food, when he clearly does not want it. (See 
Loss of Appetite, p. 94.) 



COMMOIS' MISTAKES 1'^ MILK MODIFICATIOIT AND 
INFANT FEEDING- 

I. In formulas calling for a certain number of 
ounces of top-milk, the mistake is made of removing 
only the number of ounces needed for the formula. 
The proper way is to remove the amount required to 
secure a top-milk of the desired strength and then to 
take of this the number of ounces needed in the 
formula. 

II. A rich Jersey milk is used as if it were ordi- 
nary milk. The formulas given in this book are 
chiefly calculated on the basis of a good average milk 
which contains about 4 per cent fat. Many persons 
have the idea that the richer the milk, the more rap- 
idly the child will gain in weight, and hence the 
superiority of such milk for infant feeding. While 
it is true that some children taking a very rich milk 
may, for a time, gain rapidly in weight, yet sooner 
or later, serious disturbances of digestion are nearly 
always produced. 

III. The food is increased too rapidly, particu- 
larly after some disturbance of digestion. If, in an 



94 THE CAEE AND FEEDING OF CHILDEEN 

infant three or four months old, an attack of some- 
what acute indigestion occurs, the food should sel- 
dom he given again in full strength hefore two or 
three weeks. Otherwise it generally happens that 
the attack of indigestion is very much prolonged and 
much loss in weight occurs. 

TV, When symptoms of indigestion occur, the 
food is not reduced rapidly enough. Indigestion usu- 
ally means that the organs are, for the time, unequal 
to the work imposed. If the food is immediately re- 
duced hy one-half, the organs of digestion soon re- 
gain their power and the disturbance is short. In 
every case the amount of reduction should depend 
upon the degree of the disturbance. 



THE CHANGES IN THE EOOD REQUIRED BY SPECIAL 
SYMPTOMS OR CONDITIONS 

EOSS OF APPETITE 

What is to he done when, without any other signs 
of illness, a child's appetite gradually fails? 

This is often the result of a long period of over- 
feeding or the use of milk too rich in fat. If in all 
other respects the child seems well and simply does 
not want his food, it should be offered at regular 



VOMITING 95 



hours, but not more frequently ; on no account should 
he be coaxed, much less forced, to eat, even though he 
takes only one-half or one-third the usual quantity. 
The intervals between feedings should not be short-' 
ened but rather lengthened. Often, with a child a 
year old, it is necessary for a time to reduce the num- 
ber of feedings to four or even three in twenty-four 
hours. Water, however, may be offered at more fre- 
quent intervals. The food should be weakened rather 
than strengthened. No greater mistake can be made 
than, because so little is taken, coaxing or forcing 
food at short intervals through fear lest the child may 
lose weight. 

VOMITINa 

Why is it that an infant so often vomits some of 
its food ivithin a few moments after finishing its 
'bottle? 

There are many causes besides the composition 
of the food. Usually the child is fed too often, or 
is given too much at a time ; or the food is taken too 
rapidly (in ^yq or six minutes) when the hole in 
the nipple is very large; or too slowly (twenty-five 
to thirty minutes) when the hole is very small. In 
the latter case the child often swallows a great deal 
of air and may continue to spit up small quantities 



96 THE CAEE AND FEEDING OF CHILDEEN 

of food until lie is relieved. It may be because tbe 
ebild is jounced or rocked or handled after feeding. 

How are these conditions to he remedied f 
ISTo vomiting baby should be fed oftener than 
every three hours and for many the interval should 
be four hours, even as early as the third or fourth 
month. The hole in the nipple should allow the child 
to get his food in fifteen to twenty minutes; better 
more rapidly than more slowly. 

After taking his bottle the child should be lifted 
and placed over the nurse's shoulder to allow him to 
get up the gas. Often it is well to do this in the 
middle of the feeding as well as at its close. After 
the gas has been brought up the child should be 
placed in his crib and left quietly. 

What are the changes in the food required hy 
habitual vomiting, regurgitation or frequently spit- 
ting up of small quantities of food between feedings? 

In such conditions formulas from top-milk should 
never be used, but rather those from whole milk. 
Two ounces of lime water may be added to each 
twenty ounces of food, replacing the same amount of 
plain water. 

In cases not improved by these changes it may be 
necessary to reduce the fat in the milk still further. 
This is especially true if the milk used is very rich. 



VOMITING 97 



Under these circumstances one shoiild remove some 
of the cream from the top of the bottle before shak- 
ing it. 

How much cream should he removed f 
At first four ounces may be taken off, after which 
the bottle is shaken and the balance used as in the 
formulas from whole milk. After a few days if the 
symptoms improve only three ounces of cream need 
be removed. After a few days longer only two 
ounces are removed, then only one ounce and finally 
the child is brought back to the mixtures from whole 
milk. 

Is vomiting often increased by the sugar? 

This is not likely with milk sugar if only the 
quantity mentioned in the formulas is used. How- 
ever, the use of much cane sugar or of maltose often 
aggravates the vomiting. Therefore under these con- 
ditions the use of any of the malted foods should be 
carefully avoided. 

What changes should he made in the quantity 
given at a feeding? 

It is difiicult to lay down an absolute rule. Usu- 
ally a small qu-antity of a strong food is better than 
a large quantity of a weak food. But one should not 
give more than is advised in the schedule for the age 



98 THE CAEE AND FEEDING OF CHILDREN 

of the child. To give somewhat smaller quantities is 
sometimes useful, but often this is of no assistance. 



What are tlie causes of, and food changes re- 
quired hy much gas in the stomach, leading to dis- 
tention and eructations (belching) of gas and often 
of sour food or fluid? 

This is often associated with habitual vomiting 
and is due to similar causes. It is a symptom of in- 
digestion. It is generally associated with gastric 
fermentation and is made worse by food containing 
high sugar or high fat; with such symptoms both 
should be reduced. Most of the gas in the stomach 
is air which has been swallowed. Air is swallowed 
not only when food is taken, but by many infants 
at other times. 

What changes should he made in the food when 
there is habitual flatulence and colic? 

Flatulence occurs when there is excessive forma- 
tion n-^ gas in the intestines or when the air swal- 
lowe(. asses on into the bowels. If this is readily 
expelled the child suffers no great discomfort ; but if 
not, some distention of the bowel takes place and 
colic results. 



CONSTIPATION 99 



Both these conditions are greatly aggravated by 
constipation, and to relieve the constipation is often 
the best means of controlling them. 

The gas nsnally arises from faulty digestion of 
the sugars or starch, and any of these elements of 
the food may need to be reduced, particularly 
the starch, which in many cases should be omitted 
altogether. 

COI^STIPATIOIT 

Whai changes should he made in the food for 
chronic constipation ? 

'Nothing should be done if there is one good 
stool a day. Such a condition cannot be called con- 
stipation. The constipation of the first weeks of life 
has been already referred to (page 88) ; it usually 
disappears as the food is gradually strengthened. 

Constipation is rather more frequent in infants 
fed upon formulas from whole milk than upon those 
from top-milk. A change to the latter may at times 
be beneficial. The chief element in the food, how- 
ever, which influences the bowels is the sugar. The 
daily amount of milk sugar may be increasedj hj one 
or two level tablespoonfuls over that usually ^iven^ 
or part of the milk sugar may be replaced by maltose, 
which is more laxative. A reduction in the milk 
and the use earlier or in larger amount of gruel,. 



100 THE CAEE AND FEEDING OF CHILDEEN 

especially that of oatmeal, is sometimes helpful. 
In more obstinate cases one-half or one teaspoon- 
ful of the milk of magnesia may be added to the 
daily food. The amount given may gradually be 
reduced until finally it is discontinued. To infants 
over six months, fruit juice may be given ; and to all 
constipated infants water should be given freely be- 
tween feedings. 

HOT WEATHER 

What special modifications are required during 
very hot weather? 

During the warm season it is well to make the 
proportion of fat less than during cold weather. 
During periods of excessive heat it should be much 
less. The fat is reduced by using formulas from 
whole milk in place of the 7-per-cent milk. At such 
times also the usual food should be diluted and water 
given freely between the feedings. 

K"0 GAIN TN WEIGHT 

What changes should he made in the food of a 
child ivho, unth all the signs of good digestion^ gains 
■very little or not at all in iveight? 

If the child seems hungry the quantity of food 



NO GAIN IN WEIGHT 101 

may be increased, or the food may be made stronger 
by using the next higher formula of the series. If 
the child is not hungry it is nnwise to attempt to in- 
crease either the quantity or the strength of the 
food ; for a child thrives, not npon what he swallows 
but npon wdiat he digests. Coaxing or forcing the 
child in order to increase the amount of food taken 
is almost certain to upset digestion and cause actual 
loss in weight. 

In general, such children as we are considering 
do best upon milk formulas w^hich are low in fat, 
i. e., those from whole milk or even frpm partially 
skimmed milk (page 97) rather than those from 
top-milk, and to give at the same time larger quan- 
tities of both sugar and starch than usual. The 
amount of flour may often be made one and one- 
half times or even tw^ice that usually given. With- 
out reducing the quantity of milk sugar one of the 
preparations of maltose (page QQ) may be added^ 
beginning wdth two teaspoonfuls and gradually in- 
creased to two tablespoonfuls daily, unless vomiting 
or looseness of the bowels is produced. 

It is also important to look after the other fac- 
tors in the child's life, — the care, sleep, fresh air^ 
etc., for with these rather than with the food the 
trouble often lies. 



102 THE CAEE AND FEEDING OF CHILDKEN 

What slioidd he done ivitJi infants ivlio in spite of 
all the usual variations in the milk continue to have 
symptoms of discomfort or indigestion and do not 
.thrive? 

Except inmates of institutions^ who form a class 
by themselves, most infants who receive proper care 
thrive npon milk if the proportions suited to the 
• digestion are given. Still there are some who do not, 
' The nutrition of such is always a matter of difficulty. 

If a wet-nurse is available the employment of one 
is the thing most likely to succeed, particularly if 
the infant is under three or four months old. Com- 
plete wet-nursing may be necessary for a few weeks ; 
after this partial nursing is usually sufficient. 

Some infants thrive upon hoiled milk who seemi 
to be unable to dio'est raw milk; both therefore 
should be tried. 

Success sometimes follows a change to condensed 
milk (page 117). It is more likely to agree when 
the symptoms are chieily intestinal (colic, flatulence, 
constipation, undigested stools or diarrhoea) than 
w^hen the symptoms are chiefly gastric (vomiting, re- 
; gurgitation, etc.). Condensed milk should not be 
•continued indefinitely; after a period varying from 
a few weeks to two or three months the infant should 
be brought back gradually to the usual milk formulas. 



INDISPOSITION, INDIGESTION, ETC. 103: 



IISrDISPOSITIOI^, INDIGESTION, ETC. 

What changes in the food are required hy slight 
indisposition f 

For slight general disturbances sucli as dentition, 
colds, sore throats, etc., it is usually sufficient simply 
to dilute the food. If this is but for two or three^ 
feedings, it is most easily done by replacing with 
boiled water an ounce or two of the food removed 
from the bottle just before it is given ; if for several 
days, a weaker formula should be used. 

What changes should he made for a serious acute 
illness f 

Eor such attacks as those of pneumonia, bron- 
chitis, measles, etc., attended with fever, the food 
should be diluted and the fat reduced as described 
on page 100. It should be given at regular intervals, 
rather less frequently than in health. Water should 
be given freely between the feedings. Food should 
not be forced in the early days of an acute illness, 
since the loss of appetite usually means an inability 
to digest much food. 

What immediate changes should he made in the 
food when the child has an acute attach of gastric in- 
digestion with repeated vomiting, fever, pain, etc.?' 

All milk should be stopped at once, and only 



104 THE CAEE AND FEEDING OF CHILDEEN 

boiled water given for ten or twelve hours; after- 
ward barley-water or broth may be tried, but no 
milk for at least twenty-four hours after the vom- 
iting has ceased. When beginning with modified 
milk, formulas made from skimmed milk as de- 
scribed on page 97 should be used for a few days. 
Lime-water may be added to the food. 

What changes should he made for an attach of 
intestinal indigestion with looseness of the hoivels? 

If this is not severe (only two or three passages 
•daily) , the sugar, especially milk sugar, should be 
omitted, and the milk should be boiled for five min- 
utes. If undigested milk appears in the stools, it 
may be diluted with an equal amount of barley 
water. If the diarrhoeal attack is more severe, and 
attended by fever and foul-smelling movements of 
greater frequency, all milk should be stopped im- 
mediately, and the diet mentioned just above under 
the head of acute disturbances of the stomach should 
be employed. 

What changes in the food should he made when 
the child seems to have very little appetite and yet 
is not ill? 

The number of feedings should be reduced, the 
interval being lengthened by one hour or even more. 
[N'o greater mistake can be made than to offer food 



THE ADDITION OF OTHER FOOD 105 



everv hour or two to an infant who is not hun^rv. 
That only prolongs and aggravates the disturbance. 

What other conditions besides the food greatly 
influence the child's digestion? 

Proper clothing, warm feet, regular habits, fresh 
air, clean bottles, and food given at the proper tem- 
perature, are all quite as important as the prepara- 
tion of the food; quiet, peaceful surroundings and 
absence of excitement are also essential to good di- 
gestion. In many cases in which children suffer fre- 
quently from indigestion and do not gain properly in 
weight, the fault is not with the food but with the 
care that the child receives. Both while the food is 
being taken and afterwards he should be left quite 
alone. This is particularly necessary with nervous 
children. 

THE ADDITION OF OTHER EOOD 

What food besides the milk formula may be 
given during the first year? 

Fruit juices, broth, beef juice, egg and crisp 
toast, dried bread or a milk cracker. 

When and hoiv should fruit juices be given? 
With most infants they should be begun at seven 
or eight months ; some with advanta.s^e can take them 



106 THE CARE AND FEEDING OF CHILDEEN 

as early as five or six months. At first only three or 
four teaspoonf uls once a day are given ; the quantity 
may be gradually increased until the child is given 
one ounce twice a day. The best time is about mid- 
way between the feedings. 

What fruit juices may he used? * 

Orange juice is probably the most convenient. 

The fruit should be fresh and sweet. The juice of 

fresh peaches or other ripe fruits may be used in the 

same way but should be strained. 

Of what advantage are fruit juices? 
They help to keep the bowels regular and pro- 
mote the general nutrition of the infant. 

How and when may heef juice he used? 

With average infants it may be begnin at nine or 
ten months; two teaspoonfuls may be given daily, 
diluted with the same quantity of water, fifteen min- 
utes before the midday feeding; in two weeks the 
quantity may be doubled; and in four weeks six 
teaspoonfuls may be given. The maximum quantity 
at one year should not be more than two or three 
tablespoonfuls. 

With delicate infants who are pale and anaemic, 
beef juice is more important and it may often be 



THE ADDITION OF OTHER FOOD 107 

wisely begun at -Q.Ye or six months in smaller quan- 
tities than those mentioned. 

Hoio are troths to he used? 

Mntton or chicken broth may be nsed much like 
beef juice, two or three ounces at one time. It may 
be given on alternate days with beef juice. 

Hoiu are eggs to he used? 

Two or three teaspoonfuls of a soft "coddled" 
egg may be given at nine or ten months, the amount 
beino^ 2:raduallv increased until half an eo'sr is oiven, 
and at one vear usuallv a whole ee'sr. It should of 



't>ir>' 



course be salted. Egg may be given once or twice a 
week in place of the broth or beef juice just men- 
tioned. 

The yolk of a hard boiled egg may also be grated 
fine and added to the milk of a child as young as 
six or seven months. 

It should be remembered that some infants are 
very sensitive to eggs and cannot take them at all. 

Hoivxsoon should toast and craclcers he given? 

_This- idepends somewhat on the number of teeth. 
The average child can nibble at a small piece of thin 
crisp toast when he is nine or tei) ir-'uiths old. It 
should be given at f;edingJijaiE*,Aa at fi¥st but once 



108 THE CARE AND FEEDING OF CHILDEEN 



a day. Later a larger amount may be tried. Its 
chief value is in teaching the child to chew his food. 



SUBSTITUTES FOR FEESH MIEE! 

IVhen no fresh cow's milh can he obtained, what 
substitutes are most reliable? 

Condensed milk; evaporated milk; sterilized 
milk in bottles; dried milk; goat's milk.* Of the 
condensed milks available in the United States, Bor- 
den's Eagle brand is probably the most reliable. 
This contains a large amount of cane sugar. Con- 
densed milk without any addition of sugar is sold 
in this coimtry fresh and in cans under the name 
of ^^evaporated milk." The Bear brand of Swiss 
condensed milk is perhaps as trustworthy as any ob- 
tained in Europe. 

Dried milk is derived from fresh whole milk by 
rapid evaporation of the water. ]\Iade from partially 
skimmed milk, with the addition of milk sugar, it 
is sold as a food for infants under the name of mam- 
mala. It requires only to be dissolved in water for 
feeding. A somewhat similar preparation is sold in 
Europe under the name of glaxo. Sterilized milk 
sold in bottles is widely used in Europe, but not 
much in this country. On the whole, it is not so con- 



STERILIZED, BOILED, PASTEURIZED MILK 109 

venient, and I think less reliable than condensed 
milk. 

The evaporated milk is to be preferred in infant 
feeding to the sweetened condensed milk. To this 
any form and any amount of sugar desired may be 
added; the objections to the use of the large amount 
of cane sugar are thus avoided. 

All of these substitutes are open to the same ob- 
jections, and though convenient for travelling and 
often necessary for use in foreign countries, they are 
not to be advised as permanent infant foods v^here 
fresh cow's milk can be obtained ; they are, however, 
to be preferred to the proprietary infant foods. 

Goat's milk may be had in many foreign coun- 
tries, and when fresh and produced in cleanly condi- 
tions it is to be preferred to any of the substitutes 
mentioned above as a permanent food. For most in- 
fants, it requires the same modification as cow's milk. 

STERILIZED MILK, BOILED MILK, PASTEUEIZED MILK 

What is meant hy sterilizing milhf 
Heating milk for the purpose of destroying 
germs. 

Does all coius' milk contain germs f 
Yes ; even when handled most carefully, milk con- 
tains many germs ; but when carelessly handled, and 



110 THE CAEE AND PEEDINa OF CHILDEEN 

in summer, the number is enormons. While most of 
these are harmless or cause only the souring of milk, 
others are occasionally present which may produce 
serious diseases, such as typhoid fever, diphtheria, 
scarlet fever, septic sore throat, tuberculosis, and 
some forms of diarrhoea. 

Under ivliat circumstances is it necessary to ster- 
ilize milJc? 

1. In warm weather, when it cannot be obtained 
fresh; hence always in cities and towns during the 
summer. 

2. When one cannot be certain that the cows are 
healthy, or that the milk has been carefully handled. 

3. When the milk is to be kept for any consider- 
able time (i. e., over twenty-four hours), especially 
if no ice can be had. 

4. During epidemics of typhoid or scarlet fever, 
sore throat, or dysentery. 

Whai are the tivo methods of heating milk? 

The first is known as sterilizing, in which the 
milk was at first heated to 212° F. for one hour or 
one hour and a half. ISTow it is usually sterilized 
by boiling for ten minutes. The second method is 
known as pasteurizing, in which the milk is heated 
to 155° or 160° ~E. for thirty minutes. A tempera- 
ture of 155° r. continued for thirty minutes is suffi- 



STEEILIZED, BOILED, PASTEUEIZED MILK 111 

cient to kill the germs of the diseases above re- 
ferred to. 

Will milk which has teen thus treated heep in- 
definitely f 

'No; for although all the living germs may be 
killed, there are many undeveloped germs, or spores, 
v^hich are not destroyed, and which soon grow into 
living germs. Milk heated to 212° F. for an hour 
will often keep upon ice for two or three weeks ; that 
heated to 155° F. shonld be nsed within 24 hours. 

Is milk which has heen sterilized always a safe 
food? 

]N"o; for the reason that the milk may be so old, 
so dirty, and so contaminated before sterilizing that 
it may be still unfit for infant feeding, though it 
contains no living germs. 

Is cow's milk rendered more digestible hy heing 
heated in this way ? 

For most infants, sterilizing milk does not im- 
prove its digestibility, but there are some who cer- 
tainly do better upon boiled or sterilized milk. If 
an infant is not doing well upon raw milk, boiled 
milk may be used. Sterilized milk should be modi- 
fied for infant feeding in the same way as milk 
which has not been heated. 



112 THE CARE AND FEEDING OF CHILDEEN 

Is milk in any way injured hy heating to 

Milk is rendered more constipating, and for some 
children its nutritive properties are injured, so that 
it may cause scurvy; this, however, is not likely un- 
less it is continued as the sole food for a long period. 
These objections are of so much importance that this 
plan of heating milk is not to be recommended for 
general use. Raw milk and sterilized milk are really 
different products ; each has its advantages and its 
drawbacks. 

When is it advantageous to heat milh to 212° F.? 

For use upon long journeys, such as crossing the 
ocean. Milk should then be heated for one hour 
upon two successive days, without removing the stop- 
pers from the bottles. 

Is milk in any way injured hy heating at 155° F. 
for thirty minutes? 

The unfavorable effects, if there are any, are 
so slight that they should not deter one from the 
use of pasteurized milk, even for long periods. The 
preference, however, should be given to milk which 
is so clean and so fresh as not to require any heat- 
ing; but only the cleanest and freshest milk can be 
given raw, certainly during warm weather. 



STERILIZED, BOILED, PASTEURIZED MILK 113 

How should milk he sterilized? 

ISTo special form of apparatus is required. It 
should be boiled for ten minutes in the bottles from 
which it is to be fed ; then rapidly cooled and Dlaced 
on ice. 

How should milk he pasteurized? 

A convenient form of apparatus is the Freeman 
pasteurizer ^ ; another is the Walker-Gordon pas- 
teurizer.^ Other good ones are sold in the stores. 

How should milk he cooled after pasteurizing? 

Always by placing the bottles in cold water, so as 
to cool them rapidly ; never by letting them stand at 
the temperature of the room, or by placing them, 
when warm, in an ice box. 

Why is this precaution necessary ? 

Cooling in the air or in an ice box requires from 
two to four hours, and during that time a great many 
of the undeveloped germs may mature and greatly 
injure the keeping properties of the milk. In the 
cold water milk can be cooled in from ten to twenty 
minutes if the water is frequently changed, or if ice 
is added to the water. 

* This can be obtained at 411 West Fifty-ninth Street, New 
York, with bottles and full directions; a tin one, at a cost of 
$3.50, and a copper one, which is much more durable, for $7.00. 

2 Obtained at the same prices from any of the Walker-Gordon 
milk laboratories. 
8 



114 THE CAEE AND FEEDING OF CHILDREN 

Is it better to rely upon the pasteurization of 
milk at home, or to purchase that which has been 
pasteurized before delivery? 

The home pasteurization is by all means to be 
preferred. Considerable danger may lurk in com- 
mercially pasteurized milk because of the false sense 
of security. For safety, several things are necessary : 
The milk should be reasonably clean before pasteur- 
ization ; the apparatus, the bottles, or other utensils 
containing milk should be carefully sterilized, and 
the whole process carried on with the most scrupulous 
care and cleanliness. Since pasteurization kills 
chiefly the bacteria which cause milk to sour, other 
germs, the spores of which are not killed by such 
heating, may develop rapidly unless the milk is kept 
cold, and though it may not turn sour, it may contain 
immense numbers of germs when it is delivered or 
used. It should be kept carefully iced, and used 
within twenty-four hours after heating. 

MODIFIED MILK OF THE MILK LABOEATOEIES 

What is ''modified miW of the milk labora- 
tories f 

It is milk containing definite proportions of the 
fat, sugar, protein, etc., put up usually according 
to the prescription of a physician, who indicates how 



FROZEN MILK 115 

much of the different elements he desires. The most 
reliable are the laboratories of the Walker-Gordon 
Company, which has branches in most of the large 
cities of the United States. 

This is an excellent method of having milk pre- 
pared, since it can be done with greater care and 
cleanliness than are possible in most homes. It is, 
besides, a great convenience, if circumstances make 
it impossible to prepare the milk properly at home. 

The laboratory should be used for infant feed- 
ing only by one who is somewhat familiar with this 
method of ordering milk. 



FROZEN MILK 

Is milk in any way injured for infant feeding by 
having heen frozen? 

Only the water of the milk freezes. The forma- 
tion of a little ice in the milk is of no importance; 
but when milk which has been frozen almost solid 
is thawed and later heated for use, a separation of 
the fat sometimes takes place so that it appears like 
oil at the top of the bottle. Healthy infants are 
not affected by such milk; but very delicate infants 
are sometimes upset by it, and acute diarrhoea may 
even be excited. During the few days of such ex- 



116 THE CAEE AND FEEDING OF CHILDEEN 

tremely cold weather that it is impossible to trans- 
port milk without its freezing, condensed milk may 
be substituted for such infants. 

PEPTONIZED MILK 

What is peptonized milk? 

Milk in which the protein (curd) has been par- 
tially digested. 

How is this accomplished? 

By the action of a peptonizing powder which is 
■composed of a digestive agent known as the extractum 
pancreatis an.d bicarbonate of soda, which is added 
to the plain or diluted milk. This is sold in tubes 
or in tablets, and it is the active ingredient of the 
peptogenic milk powder. 

Since it is infrequent for the protein of milk to 
be the cause of indigestion, peptonizing milk has a 
very limited use, chiefly in cases of acute illness. 

CONDENSED MILK 

What is condensed milh? 

Fresh milk which has been sterilized and then 
some of the water evaporated until one part repre- 
sents about two and a half parts of the original milk. 



CONDENSED MILK 117 

The sweetened condensed milk usually has cane sugar- 
added in the proportion of about seven ounces to one 
pint. 

Condensed milk is also sold fresh and in cans 
without any addition of cane sugar. To distinguish 
it from the usual variety, this is sometimes called 
simply '^evaporated" milk. The Peerless brand is 
perhaps the most reliable. It is about the same 
strength and requires the same dilution as the usual, 
condensed milk. 

How should condensed milTc he used? 

For an infant three or four months old with 
symptoms of indigestion, it should at first be diluted 
with 12 parts of boiled water, or, sometimes prefer- 
ably, with barley-water. With improvement in the 
symptoms, the dilution may be 1 to 11, 1 to 10, and 
1 to 8, etc., these changes being gradually made. The 
intervals between feedings and the quantities for one 
feeding are given on page 77. 

The "evaporated" milk requires the same addi- 
tion of carbohydrates (sugar and starch) as does plain 
milk. The total amount of sugar added should be 
about one ounce to twenty ounces of the food pre- 
pared. The sugar may be milk sugar, maltose or 
cane sugar, often advantageously some of each. The 
starch may be given in the form of barley, wheat, or 



118 THE CAEE AND FEEDINO OF CHILDEEN 

oat gruel, not more than eight or ten ounces in the 
■daily food. 

Is condensed milh or ^^ evaporated''' milk more 
easily digested than modified plain milk or pasteur- 
ized milk? 

By some especially delicate infants it appears to 
be, and may be tried where other forms of milk do 
not agree. 

Hoiv long should condensed milk he continued? 

In most cases it should be used as the sole food 
for a month or two only. Afterward, one feeding a 
day of a weak formula of modified milk (e. g., ISTo. II 
or III While Milk Series, page 73) may be given; 
later two feedings, and thus gradually the number of 
modified milk feedings is increased until the child is 
taking only modified milk. 

Condensed milk is not to be recommended as a 
permanent food where good fresh cow's milk can be 
obtained. 

Children reared upon it often gain rapidly in 
weight, yet have as a rule but little resistance. They 
are very prone to develop rickets, and sometimes 
scurvy. 



PEOTEIlSr MILK OE CASEIN MILK 119 



BTJTTEKMILK 

What are the advantages of huttermilk in infant 
feeding? 

Chiefly that the fat has been removed, this ele- 
ment being the one with which many children have 
difficulty; there are, besides, some changes in the 
sugar and protein, due to the slight fermentation 
which takes place in the souring of the milk. 

When is huttermilh to he employed? 
It is useful in many cases of severe chronic indi- 
gestion and in some cases of acute indigestion. 

How is it prepared and fed? 

Fresh buttermilk may be purchased at many 
dairies ; or sterilized skimmed milk may be fermented 
by various ferments sold in tablet form, such as ^^lac- 
tone," ^^ulgara," etc. ; or a specially prepared butter- 
milk may be purchased from one of the milk labora- 
tories known as ^'lactic acid milk," or elsewhere under 
a great variety of other names. It may be fed as 
prepared, or diluted with water or barley gruel. 



PROTEIIT MII.K OE CASEIIS" MILK 

What is ''casein' milk? 

This term has been given to a form of modified. 



120 THE CAEE AND FEEDING OF CHILDREN 

milk known in Germany as "eiweiss milch/' in which 
much of the milk sugar has been removed and the 
casein increased. 

When is this useful f 

Chiefly in cases of indigestion, acute or chronic, 
accompanied by diarrhoea. 

How is casein milk prepared? 

One quart of whole milk warmed to blood heat is 
coagTilated by rennet (see page 152), the whey is 
then strained off through cheese cloth and thrown 
away. The dry curd is carefully rubbed through a 
fine wire sieve with the gradual addition of one 
pint of buttermilk. Enough water is then added to 
bring the whole up to one quart. 

How is it fed? 

For older infants it is given as prepared above; 
for younger and more delicate ones it is at first di- 
luted with one fourth its volume of water. It may be 
continued for one or two weeks, or until the symp- 
toms improve; then maltose or cane sugar is slowly 
added. Later the infant is given formulas from 
whole milk (page 73). 



FEEDING DUEING THE SECOND YEAE 121 



FEEDIN^G DUEmG THE SECOINtD YEAE 

If the general directions given in previous pages 
have been followed, the infant will be taking at eleven 
or twelve months five meals, at fonr-honr intervals, 
8 or 9 ounces at a time. Of this, about three-fourths 
should be milk and one-third gruel — i. e., Formula 
XIY, page 74. Besides this, he will probably be 
receiving orange juice, one or two ounces a daj, and 
beef juice, one ounce a day. 

How mayiy meals are required in the second year? 

Usually five meals. Some children will sleep 
from 6 p. M. to 6 a. m. without waking, but unless 
there is a feeding at 10 p. m. most children are apt to 
wake very early in the morning. 

Shoidd each feeding he 'prepared at the time 
given, or all feedings at one time, as during the first 
year? 

During the second and third years it is better to 
prepare the milk for the entire day at one time. 

When only plain milk is used, the quantities 
needed for the different feedings should be put into 
separate bottles, which then may be pasteurized or 
not as is necessary. In this way the different feed- 
ings are kept separate, and the day's supply of milk 



122 THE CAEE AND FEEDING OF CHILDREN 

-_ — - 

is not disturbed every time the child is fed, as other- 
wise is unavoidable. The food should be prepared as 
soon as possible after the daily milk supply is deliv- 
ered in the morning. 

What changes may now he made in the food? 

The proportion of milk in the food may be in- 
creased ; the milk sugar may be omitted ; broth may 
be added to one of the feedings. The child should 
begin to take at least part of his food from the cup. 

Give a proper diet for an average healthy child of 
twelve months. 

6.30 A. M. Milk, six to seven ounces; diluted with barley or oat 
gruel, two to three ounces; after the thirteenth 
month, taken from a cup. 
9 A. M. Orange juice, one to two ounces. 
10 A. M. Milk, two parts; oatmeal or barley gruel, one part; 
from ten to twelve ounces in all may be al- 
lowed; it should be given from a cup. 
2 P. M. Beef juice, one to two ounces; 

or, the white of one egg, sHghtly cooked; later 
the entire egg; 

or, mutton or chicken broth, four to six ounces. 
Milk and gruel in proportions above given, four to 
six ounces. 
6 P. M. Same as at 10 a. m. 

10 p. M. Same as at 6.30 a. m., except that the food may be 
given from the bottle. 

How Jong may this schedule he followed? 

Usually until the fourteenth or fifteenth month. 
After this time the cereals may be given much thicker 
and fed from a spoon. 



FEEDING DUEING THE SECOND YEAK 123 

May any other fruit juices he given at this 
'period? 

Orange juice is the best ; next to this, the juice of 
fresh ripe peacheS;, red raspberries, or strawberries. 
All these should be strained very carefully through 
muslin to make sure that the child gets none of the 
pulp or seeds, either of which may cause serious dis- 
turbance. Of the orange or peach juice, from one to 
four tablespoonfuls may be allowed at one time; of 
the others about half the quantity. The fruit juice is 
best given one hour before the second feeding. 

When should a child he iveaned from its hottle? 

Most children can and should be taught to take 
their food from the cup or spoon before they are thir- 
teen months old; but it is convenient to give the 10 
p. M. feeding from the bottle as long as this feeding 
is continued. 

Give a proper diet for an average child from the 
fourteenth to the eighteenth month. 

The bottle should not be given except possibly at 
night. Cereals may now form an important part of 
the diet. They should be very thoroughly cooked, 
usually for three hours, but not strained. 

The daily schedule should be about as follows : 



124 THE CARE AND FEEDING OF CHILDEEN 



6.30 to 7 A. M. Warm milk, eight to nine ounces, given from a 
cup 
9 A. M. Fruit juice, one to three ounces. 
10 to 10.30 A. M. Cereal: two good tablespoonfuls of thick por- 
ridge of oatmeal, hominy or wheaten grits, 
cooked for at least three hours and not 
strained; upon this one ounce of thin 
cream or two ounces of milk, plenty of 
salt, no sugar. 
Crisp dry toast or unsweetened zwieback or 

dried bread, one piece. 
Warm milk, five to six ounces. 
- 2 p. M. Beef juice, two ounces; and one egg (soft 
boiled, poached or coddled) ; and one small, 
mealy, baked potato; 
or, broth (mutton or chicken), four ounces; 
and (if most of the teeth are present) rare 
scraped beef, aL first one teaspoonful, 
gradually increasing to one level table- 
spoonful; boiled rice (cooked five hours), 
one or two good tablespoonfuls. 
Crisp dried bread, one piece. 
No milk. 
6 p.m. Cereal: two or three good tablespoonfuls of 
farina or cream of wheat; cooked for at 
least one hour; served as at the 10 a. m. 
feeding. 
Warm milk, five to six ounces. 
10 P. M. Warm milk, six to eight ounces. 



Give a proper diet for an average child from the 
eighteenth month to the end of the second year. 

The same order of meals as for the months just 
preceding should be followed. For a few children, a 
milk feeding at 10 p. ^r. is desirable; but most chil- 
dren can readily bo trained to go from 6 p. m. to 6.30 
A. M. without food, and will sleep better than when 
fed at ten o'clock. 



FEEDING DURING THE SECOND YEAE 125 



The daily schedule should be about as follows : 

6.30 to 7 A. M. Warm milk, eight to ten ounces, given from a 
cup. 
9 A. M. Fruit juice, two to three ounces. 
10 to 10.30 A. M. Cereal, of those recommended for the four- 
teenth to the eighteenth month, three good 
tablespoonf uls ; cooked and served as de- 
scribed in the previous diet. 
Crisp dried bread, zwieback or Huntley and 

Palmer breakfast biscuits. 
Warm milk, one cup (six ounces). 
2 p. M. Beef juice, two ounces, and one soft egg; 

or, broth, four ounces, and meat, one level 
tablespoonf ul; care being taken that the 
meat is always rare and scraped or very 
finely divided; beefsteak, lamb chop or 
roast beef may be given. 
Small, thoroughly baked potato; or rice, two 

tablespoonf uls. 
Stewed carrots or fresh green peas, strained, 

one level tablespoonful. 
Prune pulp or baked apple, one to two table- 
spoonfuls. 
Water. (No milk.) 
6 P. M. Cereal: three tablespoonf uls of farina or cream 
of wheat, cooked for at least one hour; 
served as described in previous diets; and 
warm milk, eight ounces; 
or, bread and milk (stale bread, three days 
old, two sHces, and ten to twelve ounces of 
warm milk). 



Instead of the hours mentioned for the different meals in 
t^is diet and the preceding one, it is sometimes more convenient 
to give the fruit juice at 6.30 a. m. or on waking, cereal, etc., at 
7.30 and the milk at 10.30. With most children this arrangement 
answers quite as well. 

What fruits may he given at this period? 

If the child has a feeble digestion, only the fruit 



126 THE CARE AND FEEDING OF CHILDREN 

juices previously allowed ; strong children may have 
in addition prime pulp, baked apple, and apple-sauce. 
The prune pulp is prepared by stewing the dried 
prunes without sugar until they are very soft, and re- 
moving all the skin by putting the fruit through a 
strainer ; of this from one to two tablespoonfuls may 
be given at one time. The baked apple should be 
given without cream, and the apple-sauce should have 
very little sugar. 

How and when should water he given? 

Throughout the second year water should be 
given freely between the feedings, especially in warm 
weather; from one to three ounces may be given at 
one time, either from a spoon, a glass, or a bottle. 
The water should be boiled daily and then cooled. It 
should not be allowed to stand in the room, but fresh 
water should be put into the bottle each time. 

FEEDING DUKI^G THE THIED YEAE 

What changes may he made in the diet during the 
third year? 

Three regular meals should be given and milk 
once besides, either between the breakfast and dinner 
or dinner and supper, whichever is the longer inter- 
val. Water should be allowed freely between meals. 



FEEDING DUEING THE THIED YEAR 127 

£ 

What would he a proper schedule for an average 
child during the third year? 

7.30 A. M. Cereal: three good tablespoonfuls; cooked prefer- 
^ ably overnight or for three hours; a somewhat 

\^^ larger variety may be given than during the 

second year; served as described in the previous 
diets; the addition of one-half teaspoonful of 
sugar may be permitted. 
Warm milk, one cup (six ounces). 
A soft egg, poached, boiled or coddled. 
Bread (very stale or dried), one sUce, with butter. 
10.30 A. M. Warm milk, one cup (six ounces), with a milk 
cracker or piece of very stale bread with butter. 
2 p. M. Clear broth or soup (mutton or chicken in which 
rice or barley has been cooked and strained 
out), four ounces. 
Meat, two level tablespoonfuls: lamb chop, beef- 
steak, roast beef or lamb or chicken. 
A thoroughly baked white potato; 

or, boiled rice (cooked five hours). 
Green vegetable, one level tablespoonful: asparagus 
tips, string beans, peas, spinach, carrots; all 
to be cooked until very soft, and mashed, or 
preferably put through a sieve. 
Dessert: cooked fruit — baked or stewed apple or 
four or five soft stewed prunes (skins removed). 
Water. (No milk.) 
6 P. M. Cereal: three good tablespoonfuls of farina, corn 
meal or cream of wheat, cooked for at least 
one hour; served as in the morning meal; and 
one glass of milk; 
or, bread and milk; 

or, stale or dried bread with butter and a glass of 
milk. 



PART III 
THE DIET OF OLDER CHILDREN 



Ill 

THE DIET OF OLDER CHILDREN 

(fourth to tenth year) 

Throughout this period the largest meal should 
always be in the middle of the day, and a light sup- 
per given, very much like that described for the third 
year. During the first half of this period, milk may 
be allowed once either between breakfast and dinner 
or dinner and supper ; no other eating between meals 
should be permitted, but water should be allowed 
freely. 

MILK AND CREAM 

What part of the diet should milk form during 
childhood f 

It should form a very important part; nothing 
can take its place. There are comparatively few 
children who cannot take and digest milk if it is. 
properly fed. 

Why is milk so advantageous'^ 

Because no food that we possess has so high a. 

131 



132 THE CAEE AND FEEDING OF CHILDEEN 

nutritive value as milk, for the amount of work re^ 
■quired of the organs of digestion. It is, therefore, 
peculiarly adapted to the diet of the child. 

What are the essential points in the use of milk? 

It should be clean and fresh, but not too rich. It 
is a mistake to select for any children the rich milk of 
a Jersey herd and use it as though it were an ordi- 
nary milk. Xor should a child be permitted to eat a 
hearty meal of solid food and then drink one or two 
glasses of milk as if it were water. For children 
^who have difficulty in digesting milk, it should be 
partially skimmed, or diluted, i. e., one part of water 
to four parts of milk, or salt or bicarbonate of soda 
should be added. It is also desirable not to give milk 
at meals when fruits, especially raw, sour fruits, are 
allowed. 

How much milk may advantageously he given? 

The average child with good digestion should take 
two or three glasses of milk daily, this including 
only what the child drinks but not what is served 
upon cereals and in other ways. It is seldom wise to 
allow a child to take as much as one and a half or 
two quarts daily ; a more varied diet is better. 

To ivhat extent may crea?n he used? 

Older children do not require so large a proper- 



THE DIFT OF OLDEE CHILDEEN 133» 

tion of fat in their food as do infants, and the use of 
much cream, especially rich cream, often results in 
disturbances of digestion. It is a common cause of 
the coated tongue, foul breath and pale gray stools, 
often called ^^biliousness." Too much milk, espe- 
cially if it is rich milk, may produce the same result. 
Of thin ^ream or top-milk, not more than twO' 
ounces twice a day should be given. Cream should 
not be used upon fruits, particularly sour fruits. 

EGGS 

To what extent may eggs he used in the diet of 
this period f 

They form a most valuable food. It is important 
that they should be fresh, and only slightly cooked,, 
soft boiled, poached, or coddled; fried eggs should 
not be given, and most omelets are objectionable. 

The finely grated yolk of a hard-boiled egg may 
be given with advantage to many infants even as 
young as ^yq or six months. 

Is it not true that eggs often cause ''biliousness'' f 
Very seldom, if fed as above advised. This is an 
old prejudice, but has little basis in fact. 

How often may eggs he given? 
Most children from four to ten years old will take 
cue egg for breakfast and another for supper for an 



134 THE CARE AND FEEDING OE CHILDEEN 

indefinite period with relish and benefit. There are, 
however, some few who have a peculiar idiosyncrasy 
.as regards eggs, and cannot take them at all. 

MEAT AND FISH 

What meats may he given to young children? 

The best are beefsteak, lamb chop, roast beef, 
Toast lamb, chicken, turkey, and certain delicate fish, 
such as shad, trout, or bass; to those of five or six 
years a small quantity of breakfast bacon may be 
•allowed. 

What are the important points to he co7isidered in 
:giving meat to children? 

Most meats should be rare, and either scraped or 
very finely divided, as no child can be trusted to chew 
meat properly. Meats are best broiled or roasted, 
l)ut should not be fried. 

Cold meats require much chewing, and should not 
l)e allowed young children. 

How often should meat he given? 

At this period, only once a day, at the mid-day 
meal. 

7s not the excessive nervousness of many modern 
■children due to the giving of meat, or at least aggra- 
■vated hy its use? 

There is little gTound for such a belief, unless 



THE DIET OF OLDEE CHILDEEN 135 

an excessive amount of meat is given. Certainly 
cutting off meat from the diet of nervous children 
seldom produces any striking effect. 

What meats should he forbidden to young chil- 
dren? 

Ham, sausage, pork, liver, kidney, game, and all 
dried and salted meats ; also cod, mackerel and hali- 
but ; all of these are best withheld until the child has 
passed the tenth year. 

Are not gravies beneficial and nutritious? 

The beef juice, or so-called ^^platter gravy," from 
a roast is exceedingly nutritious and desirable, but 
many of the thickened gravies are much less diges- 
tible and are too often given in excess ; only a small 
quantity should be allowed. They should not form 
an important part of the meal. 

VEGETABLES 

What vegetables may be used at this period? 

White potatoes may be given first.- These should 
be thoroughly cooked and mealy, preferably baked or 
boiled and mashed, but not fried. 

Of the green vegetables, the best are peas, spin- 
ach, asparagus tips, string beans, young lima beans, 
well mashed, stewed celery, young beets, or carrots,, 



136 THE CARE AND FEEDING OF CHILDREN 

and sqiiash. Baked sweet potato, turnips, boiled 
onions, and cauliflower, all well cooked, may be given 
after the sixth or seventh year in moderate amount. 
The principal trouble in the digestion of veg- 
etables is due to imperfect cooking. It is, in fact, 
almost impossible to cook them too much; they 
should also be very finely mashed. They form a 
valuable addition to the diet after two years, al- 
though the amount at first given should be small — 
two or three teaspoonfuls. They greatly aid in se- 
curing regularity of the bowels. Because small par- 
ticles are seen in the stools, it is not to be inferred 
that they are causing disturbance and should, there- 
fore, be stopped, but only that they should be more 
thoroughly cooked and more finelv divided before 
being given. 

. Is it safe to use canned vegetahles for children? 
Many of the best brands of canned vegetables are 
quite safe, and some, such as peas and asparagus, 
can be used with advantage. They are frequently 
better than stale green vegetables often sold in the 
markets. 

What vegetahles should not he given to young 
children? 

l^one of those which are eaten raw, such as 
celery, radishes, onions, cucumbers, tomatoes, ox let- 



THE DIET OF OLDER CHILDEEN 137 

tuce. Certain others, even when well cooked, should 
not be allowed ; as com, old beets or lima beans, cab- 
bage, egg plant. 'None of these should be given until 
a child has passed the age of ten years. 

Are vegetable salads to he given? 

As a rule, salads of all kinds should be omitted 
until a child has passed the tenth year. Salads are 
somewhat difficult to digest, and unless thoroughly 
chewed may be a cause of much disturbance. 



CEEEALS 

What are the most important points in selecting 
and preparing cereals? 

The important things are that they are properly 
cooked and not used in excess. The dry or ready-to- 
serve cereals should not be chosen for children, nor 
should a child, because he is fond of cereals, be al- 
lowed to make his entire meal of them, taking two 
larffe saucerfuls at a meal; one is enough. 

For constipated children the coarse cereals should 
be chosen. 

Many of the partially cooked preparations of 
oatmeal and wheat are excellent, but should be cooked 
for a much longer time than is stated upon the pack- 
age, usually for at least two hours. Most of the 



138 THE CAEE AND FEEDING OF CHILDEEN 

grains — oatmeal, hominy, rice, wlieaten grits — re- 
quire at least three hours' cooking in a double boiler 
in order to be easily digested. Corn meal, cream of 
wheat, and farina should be cooked at least one hour. 
The "fireless cooker'' is a very useful contrivance for 
cooking cereals. ITone of the ready-to-serve cereals 
are to be recommended for children. 

Hoiv are cereals to he given? 

Usually with milk or thin cream; always with 
plenty of salt, and with very little sugar — not over 
one-half teaspoonful on a saucerful of cereal. 

Cereals should not be served with sirups or but- 
ter and sugar. 

BROTHS AT^D SOUPS 

What troths and soups are to he recommended? 

Meat broths are generally to be preferred to 
vegetable broths — ^mutton, beef, or chicken being 
usually most liked by children. Nearly all plain 
broths may be given. Those thickened with rice, bar- 
ley, or corn starch form a useful variety, especially 
with the addition of milk. 

Vegetable purees of peas, spinach, potato, celery, 
or asparag-us may be used for children over seven 
years old. Tomato soup should not be given to young 
children. 



THE DIET OF OLDEE CHILDEEN 139 



BEEAD^ CRACKERS^ AND CAKES 

Wliat forms of hreadstuffs are hesi suited to 
young children? 

Fresh bread should never be given^ but stale 
bread cut thin and freshly dried in the oven until it 
is crisp is very useful; also zwieback, the unsweet- 
ened being preferred. Very stale bread, three days 
old, may be given without drying. Oatmeal, gluten 
crackers, and the Huntley and Palmer breakfast bis- 
cuits, stale rolls or corn bread which have been split 
and toasted or dried till crisp, form a sufficient vari- 
ety for most children; sweet crackers should be 
avoided. 

What hreadstuffs should he forhiddenf 
All hot breads, fresh rolls, buckwheat and other 
griddle cakes, all fresh sweet cake, especially if cov- 
ered with icing and containing dried fruits. A stale 
lady-finger or piece of sponge cake is about as far in 
the matter of cakes as it is wise to go with children 
up to seven or eight years old. 

DESSERTS 

What desserts may he given to young children? 
Mistakes are more often made here than in any 
other part of the child's diet. Up to six or seven 



140 THE CAEE AND FEEDING OF CHILDEEN 

years, only junket, plain rice, cornstareli, or farina 
pudding without raisins, baked custard and, not more 
than once a week, a moderate amount of ice cream. 

What should he e.^pecially forbiddenf 

All pies, tarts, and pastry of every description, 

jam, sirups, and preserved fruits; nuts, candy, and 

dried fruits. 

Does ''a little'' do any liarmf 

Yes, in that it develops a taste for this sort of 
food, after which plainer food is taken with less rel- 
ish. Besides, the ''little'' is very apt soon to become 
a good deal. 

Does not the child's instinctive craving for sweets 
indicate his need of them? 

That a child likes or craves sweets is the usual 
excuse of an indulgent parent. Every child likes his 
own way, but that is no reason why he should not be 
trained to obedience and self-control ; a child's fond- 
ness for sweets can hardly be considered a normal in- 
stinct. As a matter of fact, supported by everyday 
experience, no causes are productive of more dis- 
orders of digestion than the free indulgence in des- 
serts and sweets by young children. It is a constantly 
increasing tendency, not easily controlled as a child 
grows older ; and in early childhood the only safe rule 
is to give none at all. 



THE DIET OF OLDER CHILDEEN 141 

FEUITS 

Are fruits an essential or important part of the 
diet? 

They are a very important part. They are par- 
ticularly useful for the effect they have upon the bow- 
els. It is important that they should be selected with 
care and given with much discretion, especially in 
cities. In the country, where fruit is absolutely 
fresh, a somewhat greater latitude may be allowed 
than is given below. 

What fruits may safely he given to children up to 
five years old? 

*As a general rule, only cooked fruits and the 
juices of fresh fruits. 

What fruit juices may he used? 

That from sweet oranges is the best, but the fresh 
juice of grape fruit, peaches, strawberries, and rasp- 
berries may also be used. 

What coolced fruits may he given? 

Stewed or baked apples, prunes, pears, poaches, 
and apricots. 

What raw fruits are to he particularly avoided 
with young children? 

The pulp of oranges or grape fruit, also cherries, 
berries, bananas, pineapple and raw apples, es- 
pecially between meals. 



142 THE CAEE AND FEEDING OF CHILDEEN 

What precautions should he emphasized regard- 
ing the use of fruits? 

That they should be used with greater care in 
hot weather and with children who are prone to 
attacks of intestinal indigestion. 

What symptoms indicate that fruits should he 
avoided? 

A tendency to looseness of the bowels with the 
discharge of mucus, or frequent attacks of abdominal 
pain or stomach-ache. 

Is there any special choice of meals at which 
fruit should he given? 

The fruit juice given early in the morning, upon 
an empty stomach, works more actively upon the 
bowels than if it is giren later in the day. 

It is not, as a rule, wise to give cream or milk 
with sour fruits. Usually the fruit is best given at 
the mid-day meal, as a dessert, at a time when no 
milk is taken. It is in all cases important that the 
quantity of fruit should be moderate. 

What hesides ivater and milk should a child he 
allowed to drink and what should he forhidden? 

Tea, coffee, wine, beer and cider in all quantities 
and in all forms should be forbidden to young chil- 
dren below puberty. Cocoa which is made very 
weak, i. e., almost all milk, is often useful as a hot 



INDIGESTION IN OLDEE CHILDEEN 143 

drink. Lemonade, soda-water, etc., should if pos- 
sible be deferred until the tenth year. A free in- 
dulgence in things of this kind should never be per- 
mitted with children of seven or eight years. 



INDIGESTION IN OLDER CHILDREN 

What are the different ways in which indigestion 
shows itself in children? 

First, in acute disturbances which last for a few 
days only; and, secondly, in chronic disturbances 
which may continue for weeks or months. 

Which of the two forms of indigestion is more 
likely to impair seriously the health of the child? 

Chronic indigestion; for since the cause is not 
recognized it often goes on for months and even 
years unchecked. 

What are the symptoms of acute indigestion? 

These are familiar and easily recognized. They 
are vomiting, pain, undigested movements from the 
bowels, often fever and considerable prostration. 

Such attacks are usually traceable to their 
proper cause, the removal of which is followed by 
prompt recovery. 



144 THE CAEE AND FEEDING OF CHILDEEN 

What are the common causes of acute indi- 
gestion? 

This is frequently due to overeating, to indul- 
gence in some special article of improper food, or to 
eating heartity when overtired. Acute indigestion 
often marks the beginning of some acute general 
illness. 

How should acute indigestion he managed? 

One should bear in mind that for the time being 
the digestive organs have stopped work altogether. 
The important thing, therefore, is to clear out from 
the intestines all undigested food by some active 
cathartic, such as castor oil. The stomach has 
usually emptied itself by vomiting. All food should 
be stopped for from twelve to thirty-six hours, 
according to the severity of the attack, only water 
being given. 

At the end of this time is it safe to begin ivith 
the former diet? 

^o; for such a procedure is almost certain to 
cause another attack of indigestion. At first only 
broth, thin gruel, very greatly diluted milk, or whey 
should be given. The diet may be very slowly but 
gradually increased as the child's appetite and 
digestion improve, but in most cases a week or ten 
days should elapse before the full diet is resumed. 



INDIGESTION IN OLDEE CHILDEEN 145 

What are the symptoms of chronic indigestion? 

These, although familiar, are not so easily dis- 
tinguished and are very often attributed to the 
wrong cause. There are usually general symptoms 
such as indisposition, disturbed sleep, grinding of 
the teeth, fretfulness, languor, loss of weight and 
anaemia. There are besides local symptoms: flat- 
ulence, abdominal pain, abdominal distention, con- 
stipation, or looseness of the' bowels with mucus in 
the stools, foul breath, coated tongue, loss of appe- 
tite, or an abnormal, capricious appetite. Such 
symptoms are often wrongly ascribed to intestinal 
worms. 

What are the common causes of chronic indi- 
gestion f 

This is generally the result of a bad system of 
feeding, either the prolonged use of improper food 
or of improper methods of feeding. 

Examples of bad methods of feeding are, coaxing 
or forcing to eat, rapid eating with insufficient mas- 
tication, eating between meals, allowing a child to 
have his own way in selecting his food, as when he 
lives largely upon a single article of diet. Things to 
be considered under the head of improper food are^ 
indulgence in sweets, desserts, etc., the use of imper- 
fectly cooked foods, especially cereals and vege- 
tables, and of raw or stale fruits. 



146 THE CAEE AND FEEDING OF CHILDEEN 

Is it not true that a diet or a special article 
of food which does not make a child ill is proof 
that such a diet or such a food is proper for a 
child? 

Bj no means; with many people the only guide 
in feeding children is that the article in question 
did not make the children sick, therefore it is allow- 
able. This is a very bad principle. A better one 
is to adopt such a diet as will nourish the child's 
body with the least possible tax upon his digestive 
organs; in other words, to exclude articles which 
experience has shown to be injurious to most chil- 
dren. 

How should chronic indigestion he managed? 

This is a much more difficult matter than the 
treatment of acute indigestion, for, as it is usually 
the result of the prolonged use of improper food or 
of an improper method of feeding, a cure can be 
accomplished only by a discovery and removal of 
the cause. 

Is chronic indigestion curahle? 

In the vast majority of cases it is so, but only 
by faithfully observing for a long period the rules 
for simple feeding laid down elsewhere. One of 
the greatest difficulties in the way of recovery is 
that parents and nurses are unwilling to follow a 



GENEEAL KULES^O BE OBSEEVED IN EEEDING 147 

restricted diet long enough to secure a complete 
cure, or to change radically their methods of feed- 
ing, but expect the child to recover by simply taking 
medicine. 

For how long a period is it necessary to continue 
very careful feeding? 

In any case it must be done for several months; 
with most children for two or three years; with 
some, throughout childhood, for with them the 
slightest deviation from established rules is sure to 
provoke a relapse. 

7s not medicine useful? 

It is undoubtedly of assistance for the relief of 
some symptoms, but the essential thing is proper 
feeding, without which nothing permanent can be 
accomplished. 



GENERAL RULES TO BE OBSERVED IN 
FEEDING 

Bad habits of eating are readily acquired but 
difficult to break. 

Young children should not be allowed to plaj 
with their food, nor should the habit be formed of 
amusing or diverting them while eating, because by 
these means more food is taken. 



148 THE CAEE AND FEEDING OW CHILDREN 

Older children should not be permitted to make 
an entire meal of one thing, no matter how proper 
this maj be. 

Children who are allowed to have their own 
way in matters of eating are very likely to be badly 
trained in other respects ; while those who have 
been properly trained in their eating can usually 
be easily trained to do anything else that is im- 
portant. 

Learning to eat proper things in a proper way 
forms, therefore, a large part of a child's early edu- 
cation. If careful training in these matters is begun 
at the outset and continued, the results will well 
repay the time and effort required. 

Whether the child feeds himself or is fed by the 
nurse, the following rules should be observed: 

1. Food at regular hours only; nothing between 
meals. 

2. Plenty of time should be taken. On no ac- 
count should the child bolt his food. 

3. The child must be taught to chew his food. 
Yet no matter how much pains are taken in this 
respect, mastication is very imperfectly done by all 
children; hence up to the seventh year at least, all 
meats should be very finely cut, all vegetables 
mashed to a pulp, and all grains cooked very soft. 

4. Children should not be continually urged to 



GENEEAL RULES TO BE OBSERVED IN FEEDINa 149 

eat if they are disinclined to do so at their regular 
hours of feeding, or if the appetite is habitually 
poor, and under no circumstances should a child be 
forced to eat. 

5. Indigestible food should never be given to 
tempt the appetite when the ordinary simple food is 
refused; food should not be allowed between meals 
because it is refused at meal-time. 

6. One serious objection to allowing young chil- 
dren highly seasoned food, entrees, jellies, pastry, 
sweets, etc., even in such small amounts as not to 
upset the digestion, is that children thus indulged 
soon lose appetite for the simple food which pre- 
viously was taken with relish. 

7. If there is any important article of a simple 
diet such as milk, meat, cereals, or vegetables, which 
a child habitually refuses, this should always be 
given first at the meal and other food withheld 
until it is disposed of. Children so readily form 
habits of eating only certain things an<I refusing 
others that such an inclination should be checked 
early. 

8. If an infant refuses its food altogether, or 
takes less than usual, the food should be examined 
to see if this is right. Then the mouth should be 
inspected to see if it is sore. If neither of these 
things is the cause, the food should be taken away 



150 THE CAEE AND FEEDING OF CHILDEEN 

and not offered again until the next feeding time 
comes. 

9. In any acute illness the amount of food should 
be much reduced and the food made more dilute 
than usual. If there is fever, no solid food should 
be given. If the child is already upon a milk diet, 
this should be diluted. 

10. In very hot weather the same rules hold, to 
give less food, particularly less solid food, and more 
water. 

FOOD FORMULAS 
Beef Juice, — One pound of rare round steak, 
cut thick, slightly broiled, and the juice pressed out 
by a lemon-squeezer, or, better, a meat-press. From 
two to four ounces of juice can generally be ob- 
tained. This, seasoned with salt, may be given 
cold, or warmed by placing the cup which holds it 
in warm water. It should not be heated sufficiently 
to coagulate the albumin which is in solution, and 
which then appears as flakes of meat floating in 
the fluid. 

Beef Juice by the Cold Process. — One pound of 
finely chopped round steak, six ounces of cold water, 
a pinch of salt; place in a covered jar and stand on 
ice or in a cold place, five or si:!: hours or overnight. 
It is well to shake occasionally. This is now 



FOOD FOEMULAS 151. 

strained and all the juice squeezed out by placing 
the meat in coarse muslin and twisting it very hard. 
It is then seasoned and fed like the above. 

Beef juice so made is not quite as palatable as 
that prepared from broiled steak, but it is even more 
nutritious, and is more economical, as fully twice as 
much juice can be obtained from a given quantity of 
meat. Beef juice prepared in either of these 
ways is greatly to be preferred to the beef extracts 
sold. 

Mutton Broth. — One pound of finely chopped 
lean mutton, including some of the bone, one pint 
cold water, pinch of salt. Cook for three hours over 
a slow fire down to half a pint, adding water if 
necessary; strain through muslin, and when cold 
carefully remove the fat, adding more salt if re- 
quired. It may be fed warm, or cold in the form 
of a jelly. 

A very nutritious and delicious broth is made by 
thickening this with cornstarch or arrowroot, cook- 
ing for ten minutes and then adding three ounces of 
milk, or one ounce of thin cream, to a half pint of 
broth. 

Chicken, Veal, and Beef Broths. — These are 
made and used in precisely the same manner as mut- 
ton broth. 



152 THE CAEE AND FEEDING OF CHILDEEN 

Scraped Beef or Meat Pulp. — A piece of rare 
round or sirloin steak, the outer part having been cut 
away, is scraped or shredded with a knife ; from one 
teaspoonful to one tablespoonful may be given, well 
salted, to a child of eighteen months. Scraping is 
much better than cutting the meat fine. 

For this on a large scale, as in institutions, a 
Hamburg-steak cutter may be employed. 

Junket, or Curds and Whey. — One pint of fresh 
cow's milk, warmed to blood heat ; pinch of salt ; one- 
half tablespoonful of granulatftd sugar ; add two tea- 
spoonfuls of Fairchild's essence of pepsin, or liquid 
rennet, or one junket tablet dissolved in water; stir 
for a moment, and then allow it to stand at the tem- 
perature of the room for twenty minutes, or until 
firmly coagulated; place in the ice box until thor 
oughly cold. For older children this may be seasoned 
with grated nutmeg. 

Whey. — The coagulated milk prepared as above, 
omitting the sugar, is broken up with a fork and the 
whey strained off through muslin. If some stimu- 
lant is desired, a little sherry wine may be added. 
Whey is useful in many cases of acute indigestion 
with vomiting, but not in diarrhoea. 

Barley Water. — One level tablespoonful of barley 
flour is thorouffhlv blended with a little cold water 



FOOD FORMULAS 153 



and added, stirring, to ten ounces of boiling water 
containing a pinch of salt. This is cooked for thirty 
minutes in a double boiler and then strained. 
Enough water should then be added to bring the 
whole up to one pint. 

Barley Gruel or Barley Jelly. — This is made in 
the same manner as the above, but from two to four 
level tablespoonfuls of the flour are used, according 
to the thickness of the gruel desired. 

Either barley water or barley jelly may be made 
from the grains. Eor barley water, use one heaping 
tablespoonful of pearl barley which has been soaked 
four or five hours, or overnight, one pint of water, a 
pinch of salt. This is boiled steadily for four hours, 
adding water from time to time to keep the quantity 
up to one pint. It is then strained through muslin. 

For barley gruel or barley jelly use from two to 
four tablespoonfuls of pearl barley. 

Rice, Wheat, or Oat Water. — These are made 
from rice, wheat, or oat flour exactly as barley water, 
above described. Like the barley water they may 
also be made from the grains, using the same propor- 
tions. 

Gruel or Jelly from Rice, Wheat, or Oats. — 
These are made from the flours or grains as has been 
described for barley gruel. 



154 THE CAEE AND FEEDING OF CHILDEEN 

For the wheat preparations, ordinary wheat flour 
or wheaten grits may be used. 

For the rice preparations the ordinary rice grains 
or rice flour may be used. 

For the oat preparations, either oat flour or any 
of the commonly employed forms of oatmeal may be 
used. 

When any of these farinaceous foods are to be 
mixed with milk, the milk should be added directly 
after removing the gruel from the fire, and stirred 
two or three minutes. 

Albumin Water. — The white of one fresh egg; 
half a pint of cold water ; pinch of salt ; teaspoonf ul 
of brandy. This should be shaken thoroughly and 
fed cold either with a spoon or from a bottle. It is 
useful in cases of vomiting, and can sometimes be 
retained by a very irritable stomach. 

Lime-Water, — One heaping teaspoonful of slaked 
lime; one quart boiled or distilled water; place in a 
corked bottle and shake thoroughly two or three times 
during the first hour. The lime should then be al- 
lowed to settle, and after twenty-four hours the upper 
clear fluid carefully poured or siphoned off for use. 

Dried Bread. — Either stale or fresh bread may be 
used ; it is cut in thin slices and placed on top of the 



-^^ FOOD FORMULAS 155 

stove or in the oven, v^^ith the door open, and quickly 
dried until it is crisp, but not browned. It is in 
many respects preferable to crackers for little chil- 
dren. 

Coddled Egg. — A fresh egg, shell on, is placed in 
boiling vrater which is immediately after removed 
from the fire. The egg then cooks slowly in the 
water, which gradually cools, for seven or eight min- 
utes, when the white should be about the consistency 
of jelly. For a delicate digestion the white only 
should be given, with salt ; it can be easily separated 
from the yolk. 



PART IV 
MISCELLANEOUS 



rv 

MISCELLANEOUS 

THE BOWELS 

How many movements daily should an infant 
"have during the first few weehs of life? 

Usually two or three a day for the first week, 
and then one or two each day. 

How many after a child is a month old? 

A healthy child should have at least one move- 
ment each day; many have two and some more than 
two ; but it is the character of the stools rather than 
their number which is to be taken as the evidence 
of perfect digestion. 

What is the appearance of a healthy movement 
of a child who is taking nothing hut milk? 

It is soft, yellow, and smooth, containing no 
lumps. 

When are the stools darJc brown or hlachf 
While taking bismuth, iron, and sometimes when 
taking much meat or beef juice; also while taking 
many of the prepared foods- They may be dark 

159 



160 THE CAEE AND FEEDING OF CHILDKEN 

browii or black from blood. This last is a condition 
which may indicate serious illness. 

Hoiv limy a child he trained to he regular in the 
action of its hoiuelsf 

By endeavoring to have them move at exactly 
the same timejevery day. 

At ivhat age may an infant he trmned in this 
way? 

Usually by the second month if training is be- 
gun early. 

WJiat is the hest method of training? 

A small chamber, about the size of a pint bowl, 
is placed between the nurse's knees, and upon this 
the infant is held, its back being against the nurse's 
chest and its body firmly supported. This should be 
done twice a day, after the morning and afternoon 
feedings, and always at the same hour. At first 
there may be necessary some local irritation, like 
that produced by tickling the anus or introducing 
just inside the rectum a small cone of oiled paper 
or a piece of soap, as a suggestion of the purpose 
for which the baby is placed upon the chamber; 
but in a surprisingly short time the position is all 
that is required. With most infants after a few 
weeks the bowels will move as soon as the infant is 
placed on the chamber. 



SLEEP 161 

What advantage has such training? 

It forms the habit of having the bowels move 
regularly at the same hour, which is a matter of 
great importance in infancy and makes regularity 
in childhood much easier. It also saves the nurse 
much trouble and labour. 

SLEEP 

Should a child sleep in the same hed with its 
mother or nurse? 

Under no circumstances, if this can possibly be 
avoided. Very young infants have often been 
smothered by their mothers by overlying during 
sleep. If the infant sleeps with the mother, there 
is always the temptation to frequent nursing at 
night, which is injurious to both mother and child. 
Older children also should, if possible, have separate 
beds; many contagious diseases and bad habits are 
contracted by children sleeping together. 

Hoiu should an infant's hed he prepared? 

The mattress should be firm but soft, the pillow 
very thin, and the covering not excessive. A baby 
should not be allowed to sleep always in the same 
position, but should be changed from side to side. 
Hair pillows are useful in summer and for children, 
who perspire very much. 
11 



y' 



162 THE CAEE AXD FEEDING OF CHILDKEN 



How much sleep is natural for a newly-horn 
bahy? 

A baby with a good digestion and proper food 
will nsuallj sleep at this period about nine tenths 
of the time. 

How much should a hahy sleep at six months? 
About two thirds of the time. 

Up to what age should an older child take a nap 
during the day? 

Always until four years old, and if possible 
until seven or eight years old. 

At what age may an infant go all night with- 
out feeding? 

After ^\e months a healthy child should not be 
fed or nursed between 10 p. m. and 6 a. m. Some 
children at this age habitually go from 6 p. m. to 6 
A. M. without feeding, and thrive well on this regime. 

At two years a child can easily go from 6 p. m. 
to 6 A. M. without feeding. 

How should a hahy he put to sleep? 

The room should be darkened and quiet, the 
child's hunger satisfied, and the child made gen- 
erally comfortable and laid in its crib while awake. 

Is rocking necessary? 

By no means. It is a habit easily acquired, but 



SLEEP 16a 

^__ — 

^ hard to break, and a very useless and sometimes 
injurious one. The same may be said of sucking 
a rubber nipple, or ^^ pacifier/' and all other 
devices for putting children to sleep. 

'What are {he 'principal causes of disturbed 
sleep f 

As quiet peaceful sleep is a sign of perfect 
health, disorders of sleep may be produced by almost 
anything which is wrong with the child. 

1. Habitual disturbance of sleep in infants is 
most frequently associated with the food or feeding. 
It may be from the discomfort of chronic indigestion 
due to improper food. In bottle-fed infants it is 
often the result of overfeeding; in those who are 
nursed it is often due to hunger. A common cause 
is frequent night feeding ; an infant who is fed three 
or four times during the night is almost invariably 
a bad sleeper. 

2. Disturbed sleep or sleeplessness may be due- 
to causes purely nervous. Such are bad habits ac- 
quired by faulty training; as when the nursery is 
lighted and the child taken from its crib whenever 
it wakes or cries; or when some of the contrivances 
for inducing sleep have been used. Any excitement 
or romping play just before bedtime, and fears 
aroused by pictures or stories, are frequent causes.. 



164 THE CAEE AND FEEDING OF CHILDEEN 

■Childreii who inherit from their parents a nervous 
constitution are especially likelj to suffer thus. 

3. There may be physical disconifort from cold 
■feet, insufficient or too much clothing, or want of 
:fresh air in the sleeping room. 

4. Interference with breathing due to obstruc- 
tion from large tonsils or adenoids. These cause 
great restlessness and lead a child to assume many 
•different postures during sleep, often lying upon the 
face or upon the hands and knees. 

5. Chronic pains or frequently recurring night 
pains may be causes of disordered sleep, when a 
■child wakes with a sudden sharp cry. In infants 
this is most often due to scurvy, sometimes to 
syphilis. In older children it may be the earliest 
•symptom of disease of the hip or spine. 

6. Sleeplessness and disturbed sleep are frequent 
-whenever the general condition falls much below a 
healthy standard; e. g., in infants who are not- 
thriving and in children suffering from marked 
anaemia. 

How are cliUdren lolio sleep too little, or whose 
sleep is constantly disturhed, to he treated? 

!N"ever by the use of soothing sirups or other 
medicines. Successful treatment consists in the 
discovery and removal of the cause. 



EXEECISE 165' 



Do children ever sleep too much ? 

It is doubtful if healthy children ever do. Ex- 
c^essive sleep is an important symptom of some dis- 
eases of the brain. Otherwise it seldom if ever 
occurs unless soothing sirups or other drugs have 
been given. 

EXERCISE 

Is exercise important for infants f 

It is as necessary for them as for older children. 

How is it obtained? 

A young baby gets its exercise by screaming, 
WJ^ving its arms, kicking, etc. The clothing should 
not be so tight as to make these movements impos- 
sible. At least twice a day the infant should be 
allowed for. fifteen or twenty minutes the free use of 
its limbs by permitting it to lie upon a bed in a 
warm room, with all clothing except the shirt, stock- 
ings, and napkin removed. Later, when in short 
clothes, the baby may be put upon a thick blanket 
or quilt laid upon the floor, and be allowed to tumble 
about at will. A nursery pen two feet high, made 
to surround a mattress, is an excellent device and 
makes a convenient box stall for the young animal, 
where it can learn to use both its arms and legs with- 



166 THE CARE AND FEEDING OF CHILDEEN 

out the danger of injury. Onlj bj exercise such as 
this do the muscles have an opportunity to develop 
properly. 

THE CRY 

WJien is crying useful? 

In the newly born infant the cry expands the 
lungs, and it is necessary that it should be repeated 
for a few minutes every day in order to keep them 
well expanded. 

Hoiv much crying is normal for a very young 
hahyf 

From fifteen to thirty minutes a day is not too 
much. 

What is the nature of this cry? 

It is loud and strong. Infants get red in the 
face with it; in fact, it is a scream. This is neces- 
sary for health. It is the baby's exercise. 

When is a cry ahnormal? 

When it is too long or too frequent. The ab- 
normal cry is rarely strong, often it is a moaning 
or a worrying cry, sometimes only a feeble whine. 

What are the maiii causes of such crying? 
Pain, temper, hunger, illness, and habit. 



THE CEY 167 



What is the cry of pain? 

It is usually strong and sharp, but not generally 
continuous. It is accompanied by contraction of the 
features, drawing up of the legs, and other symptoms- 
of distress. 

What is the cry of hunger? 
It is usually a continuous, fretful cry, rarely 
strong and lusty. 

What is the cry of temper? 

It is loud and strong and accompanied by kick- 
ing or stiffening of the body, and is usually violent. 

What is the cry of illness? 

There is usually more of fretfulness and moan- 
ing than real crying, although crying is excited by 
very slight causes. 

What is the cry of indulgence or from habit? 

This is often heard even in very young infants, 
who cry to be rocked, to be carried about, sometimes 
for a light in the room, for a bottle to suck, or for 
the continuance of any other bad habit which has 
been acquired. 

How can we he sure that a child is crying to he 
indulged ? 

If it stops immediately when it gets what it 
wants, and cries when it is withdrawn or withheld. 



168 THE CARE AND FEEDING OF CHILDEEN 

What should he done if a hahy cries at night? 

One should get up and see that the child is com- 
fortable — the clothing smooth under the body, the 
hands and feet warm, and the napkin not wet or 
soiled. If all these matters are properly adjusted 
and the child simply crying to be taken up, it 
should not be further interfered with. If the 
night cry is habitual some other cause should be 
sought. 

Hoio is an infant to he managed that cries from 
temper, hahit, or to he indulged? 

It should simply be allowed to " cry it out." 
This often requires an hour, and, in extreme cases, 
two or three hours. A second struggle will seldom 
last more than ten or fifteen minutes, and a third 
will rarely be necessary. Such discipline is not to 
be carried out unless one is sure as to the cause of 
the habitual crying. 

Is it likely that rupture will he caused from 
crying ? 

^N'ot in young infants if the abdominal band is 
properly applied, and not after a year under any 
circumstances. 

LIFTING CHILDREN 

How should a young hahy he lifted from its hed? 
The right hand should grasp the clothing below 



THE TEMPEEATUEE 169 

the feet, and the left hand should be slipped beneath 
the infant's body to its head. It is then raised upon 
the left arm. 

What is the advantage of this? 

The entire spine is supported, and no undue 
pressure is made upon the chest or abdomen, as 
often happens if the baby is grasped around the 
body or under the arms. 

How should a child old enough to run ahout he 
lifted? 

Always by placing the hands under the child's 
arms, and never by the wrists. 

What injury may he inflicted hy lifting the child 
hy the ivrists or hands? 

Often serious injury is done to the elbow or 
shoulder joints. 

THE TEMPERATURE 

What is the normal temperature of an infant? 

The normal temperature varies more than in 
adults. In the rectum it usually fluctuates between 
98° and 99.5° F. ; a rectal temperature of 97.5° F. 
or of 100.5° F. is of no importance whatever un- 
less it continues. 



170 THE CAEE AND FEEDING OF CHILDREN 

Where should the temperature of infants and 
young children he talcen? 

The rectum is altogether the best place, and next 
to this the groin. The rectal temperature is from 
half a degree to a degree higher than that in the 
groin. 

How long should the thermometer he left in 
place to tahe the temperature? 

Two minutes in the rectum, and -^ve minutes in 
the groin. 

Is the temperature of a young child a good guide 
as to the severity of its symptoms in illness? 

As a rule it is. A temperature of 100^ to 102° 
F. commonly means a mild illness, and one of 104° 
F. or over a serious one. The duration of the fever 
is, however, even more important than the height of 
the temperature. It should be remembered that in 
all young children slight causes often produce a high 
temperature which lasts for a few hours ; one should 
not therefore be unduly alarmed unless the tempera- 
ture continues high, or is accompanied by other im- 
portant signs of illness. 

Is not a high temperature a more serious symp- 
tom in a young child than in an adult? 

The opposite is rather the case. Young children 
are extremely sensitive to conditions which produce 



NERVOUSNESS 171 



fever, and the thermometer often gives an exagger- 
ated idea of the severity of the symptoms. A cause 
which in an adult might produce a temperature of 
102° F. or 103° F. in a young child would very 
likely be accompanied by a temperature of 104° or 
105° F. 

WEKVOUSNESS 

What are the principal causes of excessive nerv- 
ousness in infants and young children, and what can 
he done to prevent this? 

The most important cause is the delicate struc- 
ture of the brain at this time, and its rapid growth. 
It grows as much during the first year as during all 
the rest of life. This requires quiet and peaceful 
surroundings. Infants who are naturally nervous 
should be left much alone, should see but few people, 
should be played with very little, and should never 
be quieted with soothing sirups or the ^^ pacifier.'' 

At what age may playing with hahies he hegunf 
Babies under six months old should never be 
played with; and the less of it at any time the bet- 
ter for the infant. 

What harm is done hy playing with very young 
hahies? 

They are made nervous and irritable, sleep 



172 THE CAEE AND FEEDING OF CHILDEEN 

badly, and suffer from indigestion and in many 
other respects. 

When may young children he played with? 
If at all, in the morning, or after the mid-day 
nap; but never just before bedtime. 

TOYS 

What points should guide one in selecting toys 
and playthings for an infant? 

The instinct in a baby to put everything into 
the mouth is so strong that nothing should be given 
that cannot be safely treated in this way. Hence 
one should choose things which are smooth, those 
which can be easily washed, and those which can- 
not be swallowed. 

One should avoid (1) toys with sharp points or 
corners; (2) those with loose parts that might be 
detached or broken off and swallowed; (3) small 
objects which might be swallowed or pushed into 
the nose or ear, such as coins, marbles, and safety- 
pins, also beads and buttons unless strung upon a 
stout cord; (4) painted toys; (5) those covered with 
hair or wool. Infants have often been severely in- 
jured by swallowing what they have pulled off 
from their small toy animals. 



TOYS 173 

What points are to he considered in selecting the 
toys and playthings of a child over tivo years old? 

It should be remembered that toys are not 
merely a source of amusement, but that they have 
an educational value as well. Those are therefore 
to be preferred the use of v^hich develops the child's 
imagination, and with which he can be taught to 
amuse himself. For boys nothing can surpass 
blocks, toy soldiers, balls, engines and trains of 
cars; and for girls, dolls and housekeeping sets. 
The complicated mechanical toys now so much in 
vogue usually give only a momentary pleasure, and 
as soon as the wonder at their operation has worn 
off, they have lost interest for the child except that 
which he gets in breaking them to see how the thing 
worked. 

What important things can he taught children 
with their toys and hoiv may this he done? 

The imagination may be developed, and children 
may be trained to habits of neatness, order and regu- 
larity, and to concentration of mind. 

To this end toys should be kept in an orderly 
way upon a shelf in the nursery or in a closet, 
never piled in a miscellaneous heap in the corner of 
the room. Children should select their toys and 
play with one thing at a time, which they should 



174 THE CAEE AND FEEDING OF CHILDREN 

be taught to put away in its place before anothei' 
is given. Tbej should never be allowed to have a 
dozen things strewn about the room at one time, 
with none of which thej are occupied. 

KISSING 

Are there any valid objections to hissing inr 
fants? 

There are many serious objections. Tuberculo- 
sis, diphtheria, syphilis, and many other gi-ave dis- 
eases may be communicated in this way. The kiss- 
ing of infants upon the mouth by other children, 
by nurses, or by people generally, should under no 
circumstances be permitted. Infants should be 
kissed, if at all, upon the cheek or forehead, but the 
less even of this the better. 

COjSrVTJLSIO^^S 

What should he done for a child in convulsions 
before a doctor arrives? 

Keep the child perfectly quiet with ice at the 
head, put the feet in a mustard bath, and roll the 
entire body in large towels which have been dipped 
in mustard water (two heaping tablespoonfuls of 
mustard to one quart of tepid water), and have 



FOEEIGN BODIES 175 



plenty of hot water and a bath tub at hand, so that 
the doctor can give a hot bath if he thinks it advis- 
able. 

When is a hot hath useful? 

If the convulsions have continued until the pulse 
is weak, the face very pale, the nails and lips blue, 
and the feet and hands cold, the hot bath will be 
useful by bringing blood to the surface and relieving 
the heart, lungs, and brain. 

How should the hath he given? 

The temperature should not be over 106° F. ; 
this should always be tested by a thermometer if one 
can be obtained. Without this precaution, in the ex- 
citement of the moment, infants have frequently 
been put into baths so hot that serious and even fatal 
burns have been produced. If no thermometer is 
available the nurse may plunge her arm to the elbow 
into the water. It should feel warm, but not so hot 
as to be at all uncomfortable. One half a teacupful 
of powdered mustard added to the bath often adds 
to its efficacy. 

FOREIGN BODIES 

What should he done if a foreign hody has heen 
swallowed? 

First, examine the throat with the finger. If it 
has lodged there remove it. If it has passed from 



176 THE CAEE AXD FEEDING OF CHILDEEN 

the throat it has usually gone into the stomach. 
"Next he sure that the object has actually been swal- 
lowed. Often needless alarm is allayed by finding 
in the child's crib or elsewhere the thing supposed 
to have been swallowed. The stools should be ex- 
amined daily to see if the foreign body passes the 
bowel. 

What further treatment is needed? 

Give the child plenty of dry food, like bread, 
potato, etc., but under no circumstances either an 
emetic or cathartic. An infant may have its usual 
food. 

What harm luould a cathartic do? 

It is likely to hurry the foreign body too rapidly 
through the intestine and in this way do harm; 
otherwise it becomes coated with f^cal matter and 
passes the intestine usually without doing injury. 

^ot only smooth objects such as buttons or coins 
are taken care of in this manner, but even sharp 
and pointed objects such as safety pins are usually 
passed through the bowel without causing pain or 
inflicting any injury. 

Hoiu long a time is recjuired for a foreign tody 
to pass the howel? 

In most cases but three or four days, occasionally 
a week or ten days. 



COLIC 177 



What should he done if a child gets a foreign 
body into the ear? 

Unless this can easily be removed with the 
fingers it should not be meddled with, for it is likely 
to be pushed farther into the ear. The child should 
be taken to a physician. 

What should he done if there is a foreign hody 
in the nose? 

The child should blow his nose strongly while 
the empty nostril is compressed. Unless this re- 
moves it a physician should be called. Meddlesome 
interference is always harmful. 

COLIC 

What are the symptoms of colic? 

There is a strong, hard cry, which comes sud- 
denly and returns every few minutes. With this 
there is drawing up of the feet, contraction of the 
muscles of the face, and other signs of pain. The 
abdomen is usually tense and hard. 

What should he done for a hahy with colic? 

First, see that the feet are warm. Place them 

against a hot-water bag, or hold them before an open 

fire; apply a hot flannel to the abdomen, or let the 

child lie upon its stomach across a hot-water bag. 

If the colic continues, a half teacupful of warm 
12 



178 THE CARE AND FEEDING OF CHILDREN 

water containing ten drops of turpentine may be 
injected into the bowels with a syringe; at the same 
time the abdomen should be gently rubbed so as to 
start the wind. If the gas is in the stomach, half 
of a soda mint tablet may be given in a tablespoon- 
ful of very warm water. 

EARACHE 

What are the symptoms of earache? 

The pain is generally severe and accompanied by 
a sharp scream; the child often puts the hand to 
the affected ear, or cries whenever it is touched. 
The pain is likely to be prolonged and continuous. 

How should a child with earache he treated? 

The ear should be irrigated with a solution of 
boric acid (twenty grains to the ounce) as warm as 
can be borne. Dry heat may then be applied in 
several ways. The ear having been first covered 
with cotton, a small hot-water bag or one filled with 
hot salt or bran may be bound over it with a 
bandage ; or a small butter plate heated in hot water 
may be used in the same way. The hot-water bag 
may be held against the ear or the child may lie 
with his head upon it. The use of such substances 
as oil and laudanum in the ear is not to be recom- 
mended. 



CEOUP 179: 



CEOUP 

What are the symptoms of croup? 
There is a hgllow, dry, barking cough, witb 
some difficulty in breathing. 

When is this likely to come on? 
Usually at night. 

Is simple croup dangerous? 

The ordinary croup of infants is spasmodic 
croup, and is very rarely dangerous, although the- 
symptoms seem very alarming. 

What are the symptoms? 

In a mild attack there is simply noisy breath- 
ing, especially on drawing in the breath, with a 
tight, barking, or croupy cough. In a severe attack 
the child's breathing is more noisy and becomes 
difficult. 

What is the dangerous form of croup? 
Membranous croup, which is the same thing as 
diphtheria of the larynx. 

How does this develop? 

Gradually; very rarely does it come on sud- 
denly. 

What should he done for a hahy who has spas- 
modic croup? 

The room should be very warm, hot clothes or 



180 THE CAEE AND FEEDING OF CHILDEEN 

poultices should be applied over the throat, and 
«either a croup kettle or an ordinary tea-kettle kept 
boiling in the room. This is more efficacious if the 
-child is placed in a tent made by a raised umbrella 
with a sheet thrown over it, and the steam intro- 
duced beneath the tent. If the symptoms are 
urgent, ten drops of the sirup of ipecac should be 
given every fifteen minutes until free vomiting 
occurs. Whenever the symptoms reach a point 
where breathing becomes difficult, a doctor should 
be summoned without delay. 

CONTAGIOUS DISEASES 

What are the first symptoms of measles f 
Measles comes on rather gradually with cough, 
^sneezing, watery eyes and nose, much like an ordi- 
nary severe cold in the head. The eruption appears 
..after three or four days, first upon the face and 
neck as small red spots, and spreads slowly over the 
body. 

Is measles a serious disease? 

In infants and during the winter season it is 
likely to be very serious on account of the danger 
of bronchitis and pneumonia, which frequently ac- 
company it. In children over four years old it is 
generally not severe. ~^o child should be voluntarily 



CONTAGIOUS DISEASES 181. 

exposed to this disease, and particularly one who is 
delicate or prone to disease of the lungs should be 
protected against it. 

^ When and liow is measles contagious? 

Measles may readily be conveyed from the very 
beginning of the catarrh, two or three days before 
any eruption is present. It is very seldom carried 
by healthy persons. Its noison does not cling long; 
to a sick room. 

^yllat is German measles? 

German measles, or rubella, is a distinct disease 
and has nothing to do with ordinary measles. It is 
extremely rare for a child to be very ill with it. 
There is usually a very extensive eruption which, 
may cover the body, but few other symptoms. 

What are the first symptoms of scarlet fever? 

Generally it comes abruptly, with vomiting, high- 
fever, and sore throat. The eruption usually ap- 
pears within twenty-four hours as a red blush, first 
upon the neck and chest, and spreads rapidly. 

When and how is scarlet fever contagious? 

Scarlet fever is only slightly contagious for the 
first one or two days of the attack. It is most con- 
tagious at the height of the disease and during- 
desquamation. Mild cases are quite as contagious^ 



J.82 THE CAEE AND FEEDING OF CHILDEEN 

as severe ones. In fact it is bj the mild unrecog- 
nized cases that the disease is very often spread. 
It may be carried by clothing or bedding from the 
sick room and, though infrequently, by healthy per- 
sons who have been in contact with cases. 

How does luhooping-cough hegin? 

For a week or ten days it cannot be distinguished 
from the cough due to an ordinary cold on the chest. 
Then the attacks of coughing gradually become more 
severe, especially at night, the child gets red in the 
face, the eyes water with the paroxysm and vomit- 
ing may follow. After a severe coughing fit the 
I)reath is caught with a peculiar noise known as the 
"whoo]3." 

How does cMcJc en-pox hegin? 

It usually comes out gradually, as widely scat- 
tered pimples over the scalp, face, and body, many 
of which soon become small vesicles, resembling tiny 
blisters and afterwards dry to form crusts. There 
is itching and local discomfort but little fever, and 
the child rarely seems to be very ill. 

How does diphtheria begin? 

Sometimes suddenly, but usually gradually, with 
sore throat and swelling of the glands of the neck, 
with white patches upon the tonsils, or a free dis- 
■charge, which may be bloody, from the nostrils. 



CONTAGIOUS DISEASES 183 

How does mumps begin? 

As a swelling upon the jaw, just beneath the 
ear. As it increases it extends forward upon the 
cheek and backward behind the ear. It may affect 
one or both sides. 

Mumps is not very common in young children, 
and in them it is usually mild. After twelve or 
thirteen years it is likely to be more severe. 

How long after exposure do the first symptoms 
appear in the different diseases? 

In scarlet fever in from two to five days, rarely 
as late as a week; in measles in from nine to four- 
teen days, occasionally as late as twenty days; in 
whooping-cough in from one to two weeks; in 
chicken-pox in from fourteen to si^^teen days; in 
German measles in from ten to sixteen days. In 
diphtheria the time varies much; it may be only 
one day, and it may be one or two weeks. In 
mumps it is usually a little less than three weeks^ 
the average being twenty days. 

Which of these diseases are 'most contagious? 

Measles and chicken-pox are very contagious, 
and very few children who have not had them can 
come near a person suffering from either disease 
without taking it. Whooping-cough is almost as con- 
tagious as measles, and for young babies even more 



184 THE CARE AND FEEDING OF CHILDEEN 

SO. A very close exposure is not necessary in the 
case of either of these diseases, and whooping- 
cough can undoubtedly be contracted in the open 
air. Scarlet fever and diphtheria are much less con- 
tagious ; for both of these a pretty close exposure is 
necessary. 

How long should a child with any of these dis- 
eases he hept away from other children? 

With measles, for two weeks after the rash has 
gone ; with scarlet fever, for at least four weeks after 
the rash has gone, and longer if the peeling is not 
over or if the ears are running; with whooping- 
■cough, for two months, or so long as the paroxysmal 
cough continues; with chicken-pox, until all crusts 
have fallen off, or for about three weeks after the 
-eruption appears ; with German measles for one 
week after the eruption has faded; with diphtheria, 
:at least ten days after the throat is well in a very 
mild case, and four weeks if the case has been 
severe or until cultures show the throat to be free 
from the diphtheria germs; with mumps for one 
week after the swelling has gone. 

What should he done ivhen a child shows the 
first symptoms of serious illness? 

The child should be put to bed. If it is an 
infant, the food should be diluted to one half the 



SCUEVY 185 



usual strength; if an older child, only fluid food 
should be given. If the child seems feverish, take 
the temperature. If the bowels are constipated, give 
a teaspoonful of castor oil, but no other medicine 
without the doctor's orders. Send for the doctor at 
once, and until he comes carefully exclude all other 
children from the room. 

By ivliat nursery training may the examination 
and treatment of sick cJiildren he made much easier? 

By teaching all children to gargle, to show the 
throat, to take pills, and by constantly teaching them 
to regard the doctor as the child's best friend, and 
his visits as a great treat. On no account should a 
child be frightened into obedience by threats of what 
the doctor will do. 

With care and patience most children may be 
taught to gargle and take pills at four or five years, 
and to show the throat willingly at two or three. 
All these matters should be made a part of the 
child's education. 

SCUEVY 

What is scurvy and how is it produced? 

Scurvy is a disease of general nutrition, usually 
caused by the long-continued use of improper food. 
Most of the cases come from the use of the prepared 



186 THE CARE AND FEEDING OF CHILDREN 

infant's foods sold in the stores, especially when 
they are given without fresh milk; occasionally the 
use of condensed milk and of sterilized milk is fol- 
lowed by scurvy; sometimes it is seen when, owing 
to feeble digestion, it has been necessary to make 
cow's milk very weak for a long time. 

What symptoms are seen in an infant with 
scurvy f 

At first there is only indefinite and occasional 
soreness in the legs so that the child cries out when 
handled. As this soreness becomes more severe the 
child is often thought to have rheumatism. The 
gums swell and are of a deep purple colour. There 
may be bleeding from the gums, nose, bowels, or 
black-and-blue spots may be seen upon the legs. The 
ankles and knees may swell. The child grows very 
pale, loses appetite and weight, and sleeps badly. 

What should he done luhen an infant shows signs 
of scurvy? 

The diet should at once be changed to fresh milk, 
properly modified according to the child's digestion, 
but not sterilized or pasteurized. The juice of a 
sweet orange should be given, best about an hour 
before the feeding. At first three or four teaspoon- 
fuls, four or -^Ye times a day; later, more may be 
given if the symptoms are not improved. 



CONSTIPATION 187 



Properly treated an infant with scurvy generally 
recovers promptly and completely. If not recog- 
nized, or untreated, it may cause death. 

Cd^STIPATION 

When it is necessary to move the bowels imme- 
diately , ivhat are some of the easiest methods? 

An injection of one tablespoonful of sweet oil 
may be given, or half a teaspoonful of glycerine in 
one tablespoonful of water, or a teacupful of tepid 
soap and w^ater, or a glycerine suppository. ^N'one 
of these should be continued excepting under the 
physician's directions. 

What sort of a syringe is to he preferred for giv- 
ing an injection to an infant? 

The bulb syringe is the simplest ; this consists of 
an oval bulb of soft rubber and a soft rubber or a 
hard rubber tip. It holds one or two ounces. 

What is the most essential thing in preventing 
or overcoming constipation? 

The formation of the habit of having the bowels 
move every day regularly at the same hour, and 
proper early training (see page 160). 

What is the best hour? 

In most cases immediately after the first meal 
in the morning. 



188 THE CARE AND FEEDING OF CHILDEEN 

What are some simple means by ivhicli constipa- 
tion may he relieved? 

The best are diet, suppositories, and massage. 

The changes to he made in the milk of consti- 
pated infants have been mentioned on page 99. The 
addition to the milk of some of the preparations of 
maltose mentioned on page 66 is often useful. For 
little children the fruit juices are particularly 
beneficial Avhen given half an hour or more before 
the first morning feeding, with half a glass of water. 

For older children the amount of white bread, 
toast, and potato, should be reduced, and green vege- 
tables, oatmeal, and Graham bread given, with 
plenty of fruit twice a day. Eaw scraped apples are 
sometimes of more value than any other fruit. 

The best suppositories for continuous use are 
probably the gluten suppositories of the Health 
F'ood Company. One should be given the first 
thing in the morning. They act rather slowly, usu- 
ally in about two hours. In obstinate cases one may 
also be used at bedtime. Glycerine suppositories 
act more quickly, but are too irritating for regu- 
lar use. 

Massage consists in rubbing the abdomen, which 
may be done in one of two ways: Beginning at the 
right groin, the hand is carried up to the ribs, then 
across to the opposite side, then around to the left 



DIAERHCEA 189 

groin. The abdomen is stroked gently at first, and 
afterward deeper pressure used as the child becomes 
accustomed to it. The second method is by rubbing 
the deeper parts with a circular movement — the 
fingers not moving upon the skin — making a series 
of small circles, beginning at the right groin and 
following the same course as described above. 
Either method should be employed for six or eight 
minutes twice a day, at almost any regular time, 
except soon after a meal. 

DIAEEHCEA 

In case a child is tahen with diarrhoea, what 
should he done? 

With a moderate looseness of the bowels in an 
older child, solid food should be stopped, and boiled 
milk given diluted with wheat or barley gruel; the 
child should be kept in bed, as walking about always 
aggravates such a disturbance. If the symptoms are 
more severe and attended by fever and vomiting, all 
milk should be stopped at once, and only broth, 
barley water, or some thin gruel given. Some 
cathartic, usually castor oil, is required with a 
severe attack. A child of ^ve years should have 
one tablespoonf ul ; it may be given with orange 
juice or in soda water, never in milk. 



190 THE CARE AND FEEDING OF CHILDREN 

If the patient is an infant, less milk should be 
used in the formula, the sugar omitted and the fat 
reduced (see page 97.) In severe attacks with 
frequent foul stools, all food should be stopped for 
at least twelve hours and all milk for a longer time, 
and the bowels freely moved by a cathartic. 

^yiiy is a cathartic necessary if the movements 
are already frecjuent? 

Such movements are nearly always due to an 
irritation in the bowel, set up by the fermenting 
food which has not been digested. The diarrhoea 
is Xature's effort to get rid of the irritant. Nothing 
to stop the movements should be given until the 
bowels have been thoroughly cleared by the treat- 
ment mentioned. 

BAD HABITS 

What are the most common had habits of young 
children? 

Sucking, nail-biting, dirt-eating, bed-wetting, 
and masturbation. 

What do children such? 

Most frequently the thumbs or fingers, some- 
times the clothing or blanket, often the "pacifier" 
or rubber nipple. 



BAD HABITS 191 



When is this habit most frequently seen? 

It begins in qnite early infancy, and if not 
broken may last until children are six or seven 
years old. 

Is the sucking habit a harmful one? 

When persisted in it may produce a misshapen 
mouth or fingers. It constantly stimulates the flow 
of saliva and certainly aggravates disturbances of 
digestion during which the sucking habit is likely 
to be practised. It may lead to thrush or other 
forms of infection of the mouth. It is not necessary 
as a means of quieting a child, though it may in 
some degree cover up the consequences of bad feed- 
ing or bad training. On no account should the 
habit of sucking the "pacifier" be allowed as a 
means of putting children to sleep, or of quieting 
them while restless from dentition or indigestion. 

How is the sucking habit to be controlled? 

One should be sure in the first place that the 
constant sucking of fingers is not due to hunger from 
insufiicient food. Sucking of the hands may often 
be controlled by wearing mittens or fastening the 
hands to the sides during sleep. In more obstinate 
cases it may be necessary to confine the elbow by 
small pasteboard splints to prevent the child from 
bending the arm so as to get the hand to the mouth. 



192 THE CAEE AND FEEDING OF CHILDEEN 

When are nail-hit ing and dirt-eating seen, and 
how are they to he controlled? 

These habits belong especially to children over 
three years old. They are seen particularly in those 
who are excessively nervous or whose general health 
is below par ; sometimes in those who develop serious 
nervous diseases later in life. Children with such 
tendencies should be closely watched, and every 
means used to break up these habits early. Dirt- 
eating is a morbid craving which is rarely seen in 
a normal child. 

At what age may a child generally he expected 
to go without wetting the hed during the night f 

Usually at two and a half years, if it is taken 
up late in the evening. Some children acquire con- 
trol of the bladder at night when two years old, 
and a few not until three years. After three years 
habitual bed-wetting is abnormal. 

Hoiv should a young child addicted to hed- 
wetting he managed? 

At three or four years of age, punishments are 
sometimes useful, especially when it seems to de- 
pend more upon the child's indifference than any- 
thing else. They are of no value in older children, 
rewards being much more efficacious. In all cases 
one should give a child plenty of milk and water 



BAD HABITS 193 



early in the day, but no fluids after 4 p. m.^ the sup- 
per being always of solid or semi-solid food. The 
child should be taken up regularly at ten o'clock or 
thereabouts. It often happens that the formation 
or continuance of the habit is due to the child being 
anemic or otherwise in poor general condition, to 
some irritation in the urine, or in the genital organs. 
Unless the simple means mentioned are successful 
the child should be placed under the charge of a 
physician. 

What is masturbation? 

It is the habit of rubbing the genital organs with 
the hands, with the clothing, against the bed, or rub- 
bing the thighs together. Sometimes a child sits 
upon the floor, crosses its thighs tightly and rocks 
backward and forward. Many of these things are 
passed over lightly and are regarded for months as 
simply a "queer trick" of the child. It may be 
seen at any age, even in those not more than a year 
old, and in both sexes. 

How should such a child he treated? 

Masturbation is the most injurious of all the. bad 
habits, and should be broken up just as early as pos- 
sible. Children should especially be watched at the 
time of going to sleep and on first waking. Punish- 
ments and mechanical restraint are of little avail 
13 



194: THE CAEE AND FEEDING OF CHILDEEN 

except with infants. With older children thej 
usually make matters worse. Rewards are much 
more efficacious. It is of the utmost import- 
ance to watch the child closely, to keep his confi- 
dence, and by all possible means to teach self-con- 
trol. 

Some local cause of irritation is often present, 
which can be removed. Medical advice should at 
once be sought. 

VACCINATION 

Nowadays when small-pox occurs so seldom is it 
necessary to have every child vaccinated? 

It should by all means be done. It is only by 
the practice of general vaccination that small-pox is 
kept down. In countries or in communities where 
vaccination is neglected, frightful outbreaks oi 
small-pox occur every now and then just as in olden 
times. 

What is the best time for vaccination? 

The time usually selected is from the third to 
the sixth month. It may be deferred in a very 
delicate child who is not likely to be exposed to 
small-pox, or in a child suffex-ing from any form 
of skin disease. 



ADENOIDS 195 



Which is preferable for vaccination, the arm or 
the legf 

The part which can be most easily protected and 
kept at rest is to be chosen. In infants who do not 
yet walk or creep, the leg is to be preferred ; in older 
children, in most circumstances, the arm. If older 
children are vaccinated on the leg, they should not be 
allowed to walk much while the vaccination is active. 

When should vaccination he repeated? 

An unsuccessful vaccination proves nothing and 
should be repeated in two or three weeks. If suc- 
cessfully vaccinated in infancy, a child should in- 
variably be revaccinated before puberty. If exposed 
or likely to be exposed to small-pox at any time vac- 
cination should be repeated. 

ADENOIDS 

What are adenoids? 

The name is given to a lymphatic, glandular mass 
which is situated back of the nose in the upper part of 
the throat. 

Do all children have adenoids? 

They are one of the normal structures of the body. 

Under what circumstances do they require re- 
moval? 

When they become much enlarged or are the seat 
of disease. 



196 THE CAEE AND FEEDING OF CHILDREN 

What are the signs of much enlargement? 

Mouth breathing, restlessness at night, or snoring 
respiration during sleep, and in marked cases nar- 
rowing or sinking in of the lower part of the chest, 
owing to obstructed breathing and interference with 
the general health and normal growth. Also, there 
may result a narrowing of the dental arch of the up- 
per jaw leading to deformity of the mouth. 

What are the signs of diseased adenoids? 

The most common are, frequently recurring acute 
head colds or a chronic nasal discharge, and swelling 
of the glands of the neck. There may also be attacks 
of earache or more serious inflammation of the ears, 
resulting in abscesses which may discharge for a 
long time. 

Should all children have adenoids removed? 

When either group of symptoms mentioned 
above are present this should be done, and if both 
groups are present removal is imperative. When none 
of these symptoms exist operation is unnecessary. 

At what age should the operation he done? 

The time of operation is determined not so much 
by the age of the child as the urgency of the symp- 
toms. It may be necessary at any age even in an 
infant under one year. Generally speaking, opera- 
tion should be deferred until the child has passed the 
age of two or three years, as the chances of recur- 



ENLAEGED TONSILS 197 

rence are somewhat less than when the operation is 
done in infancy. 

Are adenoids liJcely to recur after 7^emoval? 

If the operation is properly performed this oc- 
curs only in a small proportion of the cases, perhaps 
10 or 15 per cent. 

ENLARGED TONSILS 

Under what circumstances should the tonsils he 
removed? 

The symptoms requiring removal are much the 
same as those described with adenoids. The ton- 
sils should be removed if they are so large that they 
obstruct respiration, or by inspection are seen nearly 
to meet in the throat. Also, when they are the seat of 
chronic disease. Often they are ragged, irregular, soft 
and spongy, although they may not be greatly enlarged. 

7s it sufficient to amputate the tonsils, or should 
they he completely removed? 

At present surgeons are generally agreed that in 
<3ases requiring operation, the complete removal of 
the tonsils is to be preferred. 

Are there any dangers from operation upon ton- 
^Is or adenoids? 

If the operation is properly performed, the risk 
is very slight indeed, but in rare cases serious hem- 
orrhage may occur. 



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INDEX 



14 



INDEX 



Adenoids, 164, 195-197. 
Air, fresh, effects of, 30. 
Airing the child, indoors, 28. 

out of doors, 29, 30. 
Airing the nursery, 26. 
Albumin water, 154. 
Alcohol lamp, 81. 
Anaemic infants, beef juice 

for, 106. 
Appetite, 86. 

lack of, food changes in- 
dicated by, 103, 104. 

loss of, 38, 94. 

overfeeding and, 91. 
Artificial feeding, 58. 

Band, abdominal, 22. 
Barley gruel, 153. 
Barley jelly, 153. 
Barley water, 152. 

use of, 52, 104. 
Baths, 15, 16. 

bran, 20. 

cold sponge, 31. 

hot, for convulsions, 175. 



Baths, salt, 20. 

Bed-wetting, 190, 192, 193. 

Beds, 161. 

Beef, scraped, 152. 

Beef broth, 151. 

Beef juice, 150. 

addition of, to milk, 106. 
by the cold process, 150. 
Beverages for children, 142. 
''Biliousness," 133. 
Bottle, for children weaned 
from the breast, 54 
preparation of, at feeding 

time, 82. 
weaning from, 55, 56, 123. 
Bottle-fed infants, mortality 

of, 44. 
Bottle-feeding and gain in 
weight, 32. 
combined with breast-feed- 
ing, 50. 
"Bottle habit," 55. 
Bottles, feeding, 79, 80. 
Bowels, in nursing mother, 47. 
in intestinal indigestion, 104. 



203 



204 



INDEX 



Bowels, movements of, after 
the first month, 159. 
during first weeks of hfe, 159. 

regularity m, 160, 161. 
when milk disagrees with 
child, 50, 51. (See also 
Constipation and Diar- 
rhoea.) 
Bran baths, 20. 
Bread, 139. 

dried, 155. 
Breast-fed infants, mortality 

of, 44. 
Breast-feeding. (See Nursing.) 
and bottle - feeding com- 
bined, 50. 
Breast-milk. (See also Milk, 
mother's.) 
age for weaning from, 53. 
composition of, 63, 64. 
Broths, 107, 138, 151. 
Bronchitis, food in, 103. 
Bunsen burner, 79, 81. 
Buttermilk, 119. 
Buttocks, care of, 20. 

Cake, 139. 

Canned vegetables, 136. 

Casein milk, 119, 120. 



Cathartics, 176, 190. 
Centrifugal cream, 68. 
Cereals, 122, 137, 138. 
Certified milk, 60. 
Chafing, 19, 20. 
Chest, average circumference 
of, table showing, 36, 
37. 
Chicken broth, 151. 
Chicken pox, 182, 183, 184. 
Circumcision, 17. 
Circumference of head and 
chest, table showing av- 
erage, 36, 37. 
Clothing, 21-23. 

during airing, 28. 

in summer, 22. 

in winter, 23. 
Coddled egg, 107, 155. 
Cold sponge baths, 31. 
Colds, causes of, 24. 

food in, 99. 

in mother, nursing during, 
53. 

prevention of, 28, 30. 
Colic, 50, 51, 92. 

in nursing infants, 52. 

symptoms of, 177. 

treatment of, 98, 177, 178 . 



INDEX 



205 



Composition of cow's milk, 63, 
64. 
of formulas from seven per 

cent, milk, 75. 
of formulas from whole 

milk, 73, 74. 
of mother's milk, 43. 
Condensed milk, 108, 116-118. 
(See also Milk, con- 
densed.) 
Constipation, 51, 52, 88, 99, 100. 
chronic, changes in food in- 
dicated by, 99, 100. 
fruit juice for, 100. 
milk of magnesia in, 100. 
treatment of, 187-189. 
weak food and, 88. 
Convulsions, treatment for, 

174, 175. 
Cow's milk. (See Milk.) 
Cream, 67, 68. 
Cream for older children, 131, 

133. 
Cream in vomiting, 96, 97. 
method of obtaining, 68. 
purchased in bulk, 61. 
richness of, 68. 
Cream-dipper, 69. 
Croup, membranous, 179. 



Croup, simple or spasmodic, 

179. 
Cry, abnormal, 166, 167 

at night, 168. 

importance of, 166. 

normal, 166. 
Curds and whey, 152. 

Dentition, 37-39. 

food in, 103. 
Desserts for young children, 

139, 140. 
Diarrhoea, treatment of, 189, 
190. 
use of band in, 22. 
Diet after weaning, 56, 57. 
during third year, 126, 127. 
for child of 12 months, 122. 
from eighteenth month to 
end of second year, 124, 
125, 126. 
from fourteenth to eigh- 
teenth month, 123, 124. 
in indigestion, 94, 143. 
in reheving constipation. 

188, 189. 
of nursing mother, 47. 
Digestion, conditions influenc- 
ing, 105. 



206 



INDEX 



Diphtheria, 182, 183, 184. 

Diphtheria of the larynx. (See 
Membranous croup.) 

Dirt-eating, 190, 192. 

Dressing and undressing, po- 
sition in, 22, 

Dried milk, 108. 

Ear, foreign bodies in, 177. 

Earache, 178. 

Eczema, omission of tub bath 

in, 16. 
Egg, coddled, 107, 155. 
Eggs, for older children, 133, 

134. 
fried, 133. 
Eggs, idiosyncrasy to, 134. 
Eggs not a cause of "biHous- 

ness," 133. 
Enlarged tonsils, 164, 197. 
Exercise, 165. 

for nursing mother, 47, 52. 
Eye teeth, 37. 
Eyes, care of, 17, 18. 

Fat, in milk, 44. 
Feeding, artificial, 58. 

at night, 90. 

before weaning an aid in 
weaning, 54. 



Feeding, duration of, 83. 
during first year, 77. 
during second year, 121-126. 
during third year, 126, 127. 
general rules for, 148-150. 
intervals of, 76-78. 
position of child during, 

83. 
regularity in, 90, 91. 
rest after, 84. 
Feeding-bottles, 79, 80. 
Fever, during teething, 38. 

in acute iUnesses, 103, 104. 
Flannels, 23. 
Flatulence, changes in food 

indicated by, 98, 99. 
Fontanel, closure of, 34. 
Food, changes in, indicated 
by failure to gain in 

weight, 100, 101. 
by gas in the stomach, 

98. 
by habitual flatulence 

and coHc, 98, 99. 
by indigestion, 102, 103, 

104. 
by lack of appetite, 104. 
by serious acute illness, 
103. 



INDEX 



207 



Food, changes in, indicated 
by slight indisposition, 

103. 
by vomiting or regurgi- 
tation, 96. 
increase in strength of, 74, 

75, 85-87, 93, 94. 
increase in quantity of, 85, 

87. 
quantity of, factors deter- 
mining, 70, 71. 
Foreign bodies in the ear, 177. 

in the nose, 177. 
Foreign bodies swallowed, 175, 

176. 
Foreskin, 17. 
Formulas, food, 150-155. 
for modified milk, 73, 74. 
from seven per cent, milk, 

75. 
to be used in acute gastric 
indigestion, 103, 104. 
Fresh air, effects of, 30. 
Frozen milk, effects of, 115. 
Fruit juices, 100, 105, 123, 141. 
Fruits, during second year, 125. 
for older children, 141, 142. 
in diet of nursing mother, 
47. 



Gas in the stomach, 51, 98. 
Gastric indigestion, acute,, 

treatment for, 103, 104, 
intervals of feeding in, 78. 
Genital organs, cleansing, 16,, 

17. 
German measles, 181, 183, 184. 
Germs in milk, 64, 109, 110 
Goat's milk, 108, 109. 
Gravies, 135. 
Gravity cream, 68. 
Gruel, 153, 154. 
for formulas from whole 

milk, 73. " 
Guaranteed milk, 60. 

Habits, bad, 190-194. 

Head, average circumference 
of, 36, 37. 
holding up, 34. 

Heating of nursery, 26. 

Height, table showing aver- 
age, 36, 37. 

Hot bath, for convulsions, 175. 

Hunger and weaning, 56. 

Ice, supply of, 62. 
Illness, and late sitting, stand- 
ing or walking, 35. 



208 



INDEX 



Illness, immediate measures in, 
184, 185. 
of nm-sing mother, 53. 
Indigestion, acute gastric, 
treatment for, 103, 104. 
and reduction in food, 88, 89. 
Indigestion and teething, 38, 
39. 
in older children, acute, 143, 
144. 
chronic, 143, 145, 147. 
intestinal, fruits and, 142. 
increase in food after, 93-94. 
intestinal,' food changes in- 
dicated by, 104. 
reduction of food in, 94. 
treatment of, 102. 
vomiting a sign of, 51. 
Infant foods and weight, 33. 
Injections, 187. 
Intestinal indigestion, 104, 

142. 
Ipecac for croup, 180. 

JelUes, 153, 154. 

Jersey milk, 58, 93. 
Junket, 152. 

Kissing, objections to, 174. 



Laughing, 34. 
Lifting children, 168, 169. 
Lime water, 154. 
use of, 64, 96, 104. 

Magnesia, milk of, for coi>- 

stipation, 100. 
Malted milk, 66. 
Maltose, 66. 
in constipation, 100. 
preparations of, 66. 
vomiting aggravated by, 97. 
Massage for reheving consti- 
pation, 188, 189. 
Mastication, 148. 
Masturbation, 193, 194. 
Meals, during second year, 121. 
during third year, 126. 
from fourth to tenth year, 
131. 
Measles, 180, 181, 183, 184. 

food in, 103. 
Meat pulp, 152. 
Meat, for young children, 134, 

135. 
MeUin's food, 66. 
Membranous croup, 179. 
Menstruation, in nursing 
mothers, 48. 



INDEX 



209 



Milk, addition of other foods 
to, 105-108. 
boiled, 102, 109. 
bottled, 61. 

care of, in the home, 60, 61. 
casein, 119, 120. 
certified, 60. 
cleanliness of, 58, 59. 
condensed, 108, 116-118. 
dried, 108. 
for children from fourth to 

tenth year, 131, 132. 
for children just weaned, 56. 
fresh, 59, 60. 
frozen, 115. 
germs in, 64, 109, 110. 
goat's, 108, 109. 
guaranteed, 60. 
handling, essentials in, 59, 

60. 
Jersey, 58, 93. 
malted, 66. 
mixed or "herd," 59. 
modified, 63, 67, 73. 

by adding lime water, 64. 

by addition of sugar, 65, 
66, 67. 

formulas for, 73, 74, 75. 

in hot weather, 100. 



Milk, mistakes in, 93, 94. 

of milk laboratories, 114, 
115. 
modified, to diminish salts 

and protein, 67. 
mother's, affected by men- 
struation, 48. 
affected by nervous con- 
ditions, 48. 
compared with cow's milk, 

63,64. 
composition of, 43. 
disagreement of, with 
child, symptoms of, 50, 
51. 
of magnesia, in constipa- 
tion, 100. 
pasteurized, 110. 

preparation of, 113, 114. 
peptonized, 116. 
preparation of, • at home, 
79-82. 
during second year, 121, 
122, 123. 
protein, 119, 120. 
purchased in bulk, 61. 
quantity of, for older chil- 
dren, 132. 
richness of, 68. 



210 



INDEX 



Milk, selection and care of, 
58-63. 
skimmed, use of, 96, 97. 
sterilized, 108, 109-113. 
digestibility of. 111. 
keeping of. 111. 
substitutes for fresh, 108, 
109. 
temperature of, 60, 82. 
whole, formulas from, 73, 74. 
Milk sugar, addition of, to 
cow's milk, 65. 
substitution for, in consti- 
pation, 100. 
Modified milk. (See Milk.) 
MortaHty of infants, 44. 
Mother, nursing, bowels and 
digestion in, 47, 52, 53. 
danger of colds in, 53. 
diet of, 47, 52, 53. 
effect of nervous condi- 
tions on, 48. 
exercise for, 47, 52. 
menstruation in, 48. 
rest for, 47. 
Mother's milk. (See Milk.) 
Mouth, cleansing of, in health, 
18. 
in sprue, 19. 



Mumps, 183, 184. 
Mutton broth, 151. 

Nail-biting, 190, 191. 
Nap, 162. 

Napkins, care of, 24. 
Nervous conditions in nursing 

mother, 48. 
Nervousness, cause of, 171. 

prevention of, 171. 
Night, feeding in, 90. 
Nipples, care of, 46. 

rubber, 79, 80. 
care of, 80. 
Nose, foreign bodies in, 177. 
Nursery, airing, 26. 

furnishings of, 25. 

heating of, 26. 

temperature of, 26. 

ventilation of, 25. 
Nursery refrigerators, 61. 
Nursing, diet of mother in, 47. 

duration of each, 46. 

during first week of life, 46. 

favorable symptoms in, 49. 

frequency of, 46. 

importance of, during first 
two or three months, 
45. 



INDEX 



211 



Nursing, reason for, 44. 
regularity of, 46. 
unfavorable symptoms in, 

49, 50. 
when contraindicated, 45. 
Nursing infants and gain in 
weight, 32. 
vomiting in, 51. 
Nursing mother. (See Moth- 
er.) 



Oat gruel or jelly, 154. 

Oat water, 153 

Omelets, 133. 

Orange juice, addition of, to 

milk, 106. 
Overfeeding, 91, 92. 

Pacifiers, 163, 190, 191. 
Pasteurizers, 113. 
Pasteurizing, 110. 

effects of, 112. 

method of, 113. 
Pastry, 140. 
Peptonized milk, 116. 
Peptonizing powder, 116. 
Playing with babies and young 
children, 171, 172. 



Pneumonia, food in, 103. 
Powder, use of, in chafing, 19, 
20. 
in prickly heat, 21. 
Pregnancy, a cause for early 

weaning, 53. 
Prickly heat, 20, 21. 
Protein in cow's milk, 64. 
in mother's milk, 43. 
use of, 44. 
Protein milk, 119, 120. 
Purees, 139. 
Pus in the eyes, 18. 

Reduction in food, reasons for, 
88. 

method of, 89. 

return from, to original for- 
mula, 89. 
Refrigerators, nursery, 61 
Regurgitation, 78, 96. 
Rest for nursing mother, 47. 
Rice gruel or jelly, 154. 
Rice water, 153. 
Rickets, 35, 38. 

condensed milk and, 118. 
Rocking, 162, 163. 
Rubella. (See German mea- 
sles.) 



212 



INDEX 



Rupture, not caused by cry- 
ing, 168. 

Salads, 137. 

Salt baths, 20. 

Salt solution for cleansing 

the eyes, 17. 
Salts in cow's millc, 64. 

in mother's milk, 43, 44. 
Scarlet fever, 181, 182, 183, 

184. 
Schedule for feeding during 
first year, 77. 
during second year, 122, 

124, 125. 
during third year, 127. 
Scraped beef, 152. 
Scurvy, 164, 185, 186. 
condensed milk and, 118. 
due to artificial foods, 58. 
sterilized milk and, 112. 
Second year, feeding during, 

121-126. 
Separator, 68. 

Seven per cent, milk, 68, 69. 
(See also Top-milk.) 
formulas from, 75. 
method of obtaining, 69. 
Sitting alone, 84. 



Skimmed milk, use of, 96, 
97. 

Skimming milk, 68, 69. 

Skin, care of, 19-21. 

Sleep, 161, 162, 165. 
disturbed, 163, 164. 

Sleeping, out of doors, 30. 

Sleeplessness, 163. 

Soda, bicarbonate of, in sprue, 
19. 

Sore throat, food in, 103. 

Soups for small children, 138. 

Sponge bath, cold, 31. 

Sponges, 16. 

Sprue, 18, 19. 

Standing alone, 34. 

Sterihzation of milk pails, bot- 
tles, etc., 59. 

Sterihzed milk, 108, 109-113. 

Stomach, gas in, 98, 99. 

Stomach teeth, 38. 

Stools, appearance of, 159. 
brown or black, 153, 154, 
159. 

Substitutes for fresh milk, 108, 
109. 

Sucking, 190, 191. * 

Sugar, granulated, 65. 
in cow's milk, C4. 



INDEX 



213 



Sugar, in modifying milk, 67. 

in mother's millc, 43, 44. 
Sugar, milk, 65. (See Milk 
sugar.) 

vomiting aggravated by, 97. 
Summer, clothing in, 22. 

modifications in food in, 100. 

steriHzed milk in, 110. 
Suppositories, 188. 
Sweet oil in chafing, 20. 
Sweets for young children, 

139, 140. 
SyphiUs, 164. 

Syringe for use with infants, 
187. 

Talking, 35, 36. 
Teeth, first set of, time of 
appearance of, 37, 38. 
Teething, symptoms of, 38, 39. 

weight and, 33, 39. 

(See also Dentition.) 
Temperature, for bathing, 15. 

for out of door airings, 29. 
Temperature of children, high, 
169, 170. 

in illness, 170. 

method of taking, 170. 

normal, 169. 



Temperature of milk, 62. 
testing, 82, 83. 
of nursery, 26. 
of refrigerators, 62. 
of water for cold sponge 
bath, 31. 
for hot bath, 175. 
Thermometer, dairy, 83. 
"Thermos bottle." (See Vac- 
uum bottle.) 
Third year, feeding during, 

126, 127. 
Thrush, 18, 19.. 
Tonsil, enlarged, 164, 197. 
Top-milk, definition of, 68. 
removal of, 61, 68, 69, 

93. 
seven per cent., method of 
obtaining, 69. 
Toys, first reaching for, 34. 
means of training, 175. 
selection of, 172, 173. 
Training, a preventive of con- 
stipation, 187. 
and illness, 185. 
in regular feeding, 90. 
in regularity of bowel move- 
ments, 160, 161. 
Tub bath, age for, 15. 



214 



INDEX 



Tuberculosis, a contraindica- 
tion to maternal nurs- 
ing, 45. 

Underclothing, in summer, 22. 
in cold weather, 23. 

Vaccination, 194, 195. 
Vacuum bottle, uses, 62. 

objections to, 62. 
Veal broth, 151. 
Vegetables, for small children, 
135-137. 
canned, 136. 
Ventilation of nursery, 26. 
Vinegar and water, use of, in 

prickly heat, 21. 
Vomiting, 76. 
causes of, 95. 
changes in food indicated 

by, 96, 97. 
changes in intervals of feed- 
ing indicated by, 96. 
in acute gastric indigestion, 

103. 
in nursing infants, 51, 52. 
in teething, 38. 
intervals of feeding and, 
77, 78. 



Vomiting, quantity of food in, 
95. 
symptom that milk dis- 
agrees with child, 50, 51. 

Walker-Gordon milk labora- 
tories, 113, 115. 
Walking, 35. 
Washcloths, 16. 
Water, boiled, in acute gastric 
indigestion, 103. 
during first two days of Hfe, 

45. 
during second year, 126. 
in acute illness, 103. 
in hot weather, 100. 
in modifying milk, 67, 72, 73. 
in mother's milk, 43, 44. 
in weaning, 54. 
to dilute breast-milk, 52. 
Weaning from bottle, 55. 
123. 
age for, 55. 

delayed, objections to, 55- 
method of, 55. 
from breast, age for, 53. 
diet after, 56, 57. 
due to loss of weight, 50. 
early, reasons for, 53. 



INDEX 



215 



Weaning from breast, how to 
overcome difficulties of, 
54. 
in sunmaer, 54. 
loss of weight at, 32. 
method of, 54. 
when milk disagrees with 
child, 50, 51. 
Weighing, frequency of, 31. 
Weight, after weaning, 57. 
at birth, 33. 

during first weeks of artifi- 
cial feeding, 87. 
Weight, failiu-e to gain in, and 
food, 100, 101. 
treatment of, 100, 101. 
gain in, during first year, 32, 
33. 
in bottle-fed and nursing 
infants, 32. 
importance of, 31. 



Weight in second year, 34. 

overfeeding and, 92. 

record of, 31. 

strength and, 33. 

table showing average, 36, 
37. 

teething and, 33, 39. 

weaning and, 48, 49. 
Weight charts, 199, 200. 
Wheat gruel or jelly, 154. 
Wheat water, 153. 
Whey, 151. 
Whole milk, formulas from, 

73, 74. 
Whooping cough, 182, 183, 

184. 
Windows open at night, 26. 
Winter, clothing in, 23. 

Yolk of egg, grated, for infants, 
133. 



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